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Anesth Analg 1985; 64:23-29
© 1985 International Anesthesia Research Society
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Pharmacokinetics and Pharmacodynamics of d-Tubocurarine and Metocurine in the Elderly

Richard S. Matteo, MD, Walter W. Backus, MD, Dudley D. McDaniel, MD, William P. Brotherton, MD, Robin Abraham, MS, and Jaime Diaz

Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, and the Anesthesiology Service, Presbyterian Hospital, New York, New York.

Abstract

The effects of age (older than 70 yr) on the pharmacokinetics and pharmacodynamics of d-tubocurarine (dTc) and metocurine (MTc) were evaluated in studies of 21 patients aged 70–87 and 21 patients aged 29–59. There was a significant difference in the pharmacokinetic parameters of all elderly patients compared with younger controls. With both dTc and MTc, the elderly exhibited a decreased plasma clearance, decreased initial volume of distribution, decreased volume of distribution, and a prolonged elimination half-life. After 0.3 mg/kg of dTc, the times for 50% return of twitch and recovery index (25–75% return of twitch response) in the elderly were significantly longer than in the young (P < 0.02). A similar observation was made for the elderly patients receiving 0.15 mg/kg of MTc. No significant difference was seen in the log plasma concentration-twitch response relationship between 20–80% paralysis in young arid in elderly patients receiving dTc. There was a similar lack of significant difference between the log plasma concentration-twitch response lines for elderly and young patients receiving MTc. Because there was no difference between the plasma concentration-response relationships in the elderly and young, altered sensitivity to dTc or MTc cannot explain the longer duration of action seen in the elderly. The most likely explanation for this difference is the altered pharmacokinetics of these two drugs in the elderly.

Key Words: NEUROMUSCULAR RELAXANTS—d-tubocurarine, metocurine • PHARMACOKINETICS—d-tubocurarine, metocurine • PHARMACODYNAMICS—d-tubocurarine, metocurine




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1985 by the International Anesthesia Research Society.