Abstract
Rocuronium, a non-depolarizing neuromuscular blocking drug has a rapid onset of action, a comparatively low potency and, with a more favourable side effects profile than succinylcholine, it has become a popular alternative to that drug for rapid sequence inductions in anaesthesia. The rocuronium-binding cyclodextrin derivative sugammadex, prepared by per-6 substitution of the primary hydroxyls of γ-cyclodextrin with thiol ether-linked propionic acid side chains to extend the hydrophobic cavity to accommodate rocuronium, is used to reverse neuromuscular blockade by encapsulating the drug as an inclusion complex and removing it from the neuromuscular junction to the plasma. It has recently been suggested that sugammadex might also be of value in the management of rocuronium-induced anaphylaxis and this has been potentially supported by recent case reports. However, before sugammadex can be recommended for this purpose, it is important to establish whether or not the allergenic substituted ammonium groups at each end of the rocuronium molecule in the inclusion complex are masked within the cavity or left exposed for interaction with rocuronium-reactive IgE antibodies in the sera of rocuronium-allergic patients. Detailed experimental strategies and experimental protocols to investigate the allergenic potential of the sugammadex-rocuronium inclusion complex are presented and a possible explanation of the apparently rapid and successful reversal of anaphylaxis by administration of sugammadex is advanced and discussed.
Keywords: Sugammadex, perioperative anaphylaxis, cyclodextrins, drug allergy, rocuronium, drug-specific IgE.
Mini-Reviews in Medicinal Chemistry
Title:The Cyclodextrin Sugammadex and Anaphylaxis to Rocuronium: Is Rocuronium Still Potentially Allergenic in the Inclusion Complex Form?
Volume: 12 Issue: 8
Author(s): B. A. Baldo, N. J. McDonnell and N. H. Pham
Affiliation:
Keywords: Sugammadex, perioperative anaphylaxis, cyclodextrins, drug allergy, rocuronium, drug-specific IgE.
Abstract: Rocuronium, a non-depolarizing neuromuscular blocking drug has a rapid onset of action, a comparatively low potency and, with a more favourable side effects profile than succinylcholine, it has become a popular alternative to that drug for rapid sequence inductions in anaesthesia. The rocuronium-binding cyclodextrin derivative sugammadex, prepared by per-6 substitution of the primary hydroxyls of γ-cyclodextrin with thiol ether-linked propionic acid side chains to extend the hydrophobic cavity to accommodate rocuronium, is used to reverse neuromuscular blockade by encapsulating the drug as an inclusion complex and removing it from the neuromuscular junction to the plasma. It has recently been suggested that sugammadex might also be of value in the management of rocuronium-induced anaphylaxis and this has been potentially supported by recent case reports. However, before sugammadex can be recommended for this purpose, it is important to establish whether or not the allergenic substituted ammonium groups at each end of the rocuronium molecule in the inclusion complex are masked within the cavity or left exposed for interaction with rocuronium-reactive IgE antibodies in the sera of rocuronium-allergic patients. Detailed experimental strategies and experimental protocols to investigate the allergenic potential of the sugammadex-rocuronium inclusion complex are presented and a possible explanation of the apparently rapid and successful reversal of anaphylaxis by administration of sugammadex is advanced and discussed.
Export Options
About this article
Cite this article as:
A. Baldo B., J. McDonnell N. and H. Pham N., The Cyclodextrin Sugammadex and Anaphylaxis to Rocuronium: Is Rocuronium Still Potentially Allergenic in the Inclusion Complex Form?, Mini-Reviews in Medicinal Chemistry 2012; 12 (8) . https://dx.doi.org/10.2174/138955712801264828
DOI https://dx.doi.org/10.2174/138955712801264828 |
Print ISSN 1389-5575 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5607 |
Call for Papers in Thematic Issues
Bioprospecting of Natural Products as Sources of New Multitarget Therapies
According to the Convention on Biological Diversity, bioprospecting is the exploration of biodiversity and indigenous knowledge to develop commercially valuable products for pharmaceutical and other applications. Bioprospecting involves searching for useful organic compounds in plants, fungi, marine organisms, and microorganisms. Natural products traditionally constituted the primary source of more than ...read more
Computational Frontiers in Medicinal Chemistry
The thematic issue "Computational Frontiers in Medicinal Chemistry" provides a robust platform for delving into state-of-the-art computational methodologies and technologies that significantly propel advancements in medicinal chemistry. This edition seeks to amalgamate top-tier reviews spotlighting the latest trends and breakthroughs in the fusion of computational approaches, including artificial intelligence (AI) ...read more
Natural Products and Dietary Supplements in Alleviation of Metabolic, Cardiovascular, and Neurological Disorders
Metabolic disorders like diabetes, obesity, inflammation, oxidative stress, cancer etc, cardiovascular disorders like angina, myocardial infarction, congestive heart failure etc as well as neurological disorders like Alzheimer?s, Parkinson?s, Epilepsy, Depression, etc are the global burden. They covered the major segment of the diseases and disorders from which the human community ...read more
Natural Products in Drug Discovery
Natural products have always been one of the important ways of drug discovery due to their novel skeleton and diverse functional group characteristics. According to statistics, between 1981 and 2019, the FDA approved a total of 1,394 small molecule drugs for marketing, of which 930 marketed drugs originated from the ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
Disruption of Circadian Rhythms and Delirium, Sleep Impairment and Sepsis in Critically ill Patients. Potential Therapeutic Implications for Increased Light-Dark Contrast and Melatonin Therapy in an ICU Environment
Current Pharmaceutical Design Role of Nitrosative Stress and Peroxynitrite in the Pathogenesis of Diabetic Complications. Emerging New Therapeutical Strategies
Current Medicinal Chemistry Epidemiology and Costs of Hypertension-related Disorders
Current Pharmaceutical Design Tanshinone IIA: Pharmacology, Total Synthesis, and Progress in Structure-modifications
Current Medicinal Chemistry Management of Food-Induced Anaphylaxis: Unsolved Challenges
Current Clinical Pharmacology Patent Selections:
Recent Patents on Cardiovascular Drug Discovery Molecular Aspects of Modulation of L-type Calcium Channels by Protein Kinase C
Current Molecular Pharmacology Calcium Store Stability as an Antiarrhythmic Endpoint
Current Pharmaceutical Design Selective VEGFR Inhibitors for Anticancer Therapeutics in Clinical Use and Clinical Trials
Current Pharmaceutical Design Small Molecule Antagonists of the Chemokine Receptor CCR5
Current Topics in Medicinal Chemistry Human Cardiac Ryanodine Receptor: Preparation, Crystallization and Preliminary X-ray Analysis of the N-terminal Region
Protein & Peptide Letters Metabolism of Antiarrhythmics
Current Drug Metabolism Chemical Connexin Impairment in the Developing Gonad Associated with Offspring Infertility
Current Medicinal Chemistry The Role of Chinese Herbal Medicines and Bioactive Ingredients Targeting Myocardial KCa and KATP Channels in Cardiovascular Diseases
Current Pharmaceutical Design Admission, 24 Hours and Discharge Troponin T Among Acute Myocardial Infarction Patients: Differing by Prognostic Contribution
Recent Patents on Biomarkers Enzyme Replacement Therapy in Fabry Disease: Influence on Cardiac Manifestations
Current Medicinal Chemistry Cardiac and Muscular Involvement in Idiopathic Inflammatory Myopathies: Noninvasive Diagnostic Assessment and the Role of Cardiovascular and Skeletal Magnetic Resonance Imaging
Inflammation & Allergy - Drug Targets (Discontinued) The hERG Channel and Risk of Drug-Acquired Cardiac Arrhythmia: An Overview
Current Topics in Medicinal Chemistry Mesenchymal Stem Cells Enhanced Cardiac Nerve Sprouting via Nerve Growth Factor in a Rat Model of Myocardial Infarction
Current Pharmaceutical Design Risk Stratification for Sudden Cardiac Death: Current Approaches and Predictive Value
Current Cardiology Reviews