Which benzylisoquinolinium nondepolarizing neuromuscular blocking drug is unique among this class of drugs in that it does not cause release of histamine?

Which benzylisoquinolinium nondepolarizing neuromuscular blocking drug is unique among this class of drugs in that it does not cause release of histamine?

• A. d-Tubocurarine
• B. Cisatracurium
• C. Rocuronium
• D. Atracurium

Answer: (B)

Histamine release from mast cells is a common adverse effect that helps differentiate benzylisoquinolinium nondepolarizing blockers. This release can cause flushing, hypotension, and sometimes bronchospasm. Among these drugs, d-tubocurarine is well known for causing significant histamine release, and atracurium also can provoke histamine-mediated hypotension. Cisatracurium, on the other hand, is a stereoisomer of atracurium designed to minimize mast cell degranulation and thus has little to no clinically relevant histamine release, giving a more stable blood pressure profile. Rocuronium is not a benzylisoquinolinium blocker, so it isn’t part of this comparison. So the one that uniquely avoids histamine release within this class is cisatracurium.

Histamine release from mast cells is a common adverse effect that helps differentiate benzylisoquinolinium nondepolarizing blockers. This release can cause flushing, hypotension, and sometimes bronchospasm. Among these drugs, d-tubocurarine is well known for causing significant histamine release, and atracurium also can provoke histamine-mediated hypotension. Cisatracurium, on the other hand, is a stereoisomer of atracurium designed to minimize mast cell degranulation and thus has little to no clinically relevant histamine release, giving a more stable blood pressure profile. Rocuronium is not a benzylisoquinolinium blocker, so it isn’t part of this comparison. So the one that uniquely avoids histamine release within this class is cisatracurium.