FRCA Notes


Tubocurarine and Gallamine


  • Tubocurarine is a monoquaternary alkaloid with a tertiary amine group
  • It is a non-depolarising NMBA
  • Presents as a colourless solution of 10mg/ml
  • Dose of 0.5mg/kg provides intubating conditions in 3mins
  • Variable duration of action (approx. 40mins)

Absorption and distribution

  • pKa of 8.0
  • 30-50% protein bound
  • In acidic conditions:
    • The tertiary amine group is protonated, which increases potency
    • However plasma [K+] will also rise, altering membrane potential and offsetting the increased potency

Metabolism and excretion

  • Excreted as unchanged drug in the urine (70%) and bile (30%)
  • Accumulates in renal failure, though more is then excreted in the bile

Cardiovascular

  • Blocks autonomic ganglion therefore no reflex tachycardia to the hypotension

Gastrointestinal

  • Sialorrhoea

Adverse features

  • Histamine release, which causes hypotension
  • Anaphylaxis

  • Gallamine is a benzylisoquinolinium NMBA
  • Gallamine has a limited clinical role
  • It may reduce the fasciculations caused by suxamethonium
  • Selectively blocks cardiac muscarinic receptors and may cause a tachycardia
  • Alkalosis prolongs its duration of action
  • Excreted unchanged by kidneys and renal failure may significantly prolong its half-life