Feedback in the Clinical Setting with Jamie Rubin, MD

Chronic anticonvulsant therapy (CAT) results in changes in pharmacokinetics and pharmacodynamics of neuromuscular blockers, including pancuronium, vecuronium, rocuronium, and cisatracurium. Patients on CAT tend to require a higher steady-state concentration (increased resistance to blocking effect) to achieve 95% twitch depression and tend to recover more rapidly (increased clearance). The mechanism behind this faster recovery is not well understood. Pharmacokinetic as well as pharmacodynamic factors could be implicated, including hepatic enzyme induction, greater plasma protein binding, increased number or decreased sensitivity of the acetylcholine receptors, or direct competition for binding sites.