All are true about gantacurium-except
Gantacurium was the first compound of this new class of neuromuscular blocking drugs, the asymmetric mixed-onium chlorofumarates. Gantacurium is an asymmetric enantiomeric isoquinolinium diester of chlorofumaric acid . Gantacurium, like cisatracurium, is a single isomer as atracurium and mivacurium are consisting of a mixture of isomers . Gantacurium is an ultra-sho acting non-depolarizing neuromuscular blocking drug with a rapid onset and a wide safety margin . As cisatracurium and atracurium are inactivated by Hofmann elimination, gantacurium is metabolized by chemical degradation which involves cysteine adduction (fast process) and pH-sensitive hydrolysis (slow process) . Cysteine adduction results in replacement of chlorine by cysteine whereafter a heterocyclic ring is formed which cannot longer interact with the postjunctional acetylcholine receptor. Therefore, the metabolites of gantacurium showed no neuromuscular propeies . Moreover, there is no renal and hepatic involvement in the elimination of gantacurium . Reversal of a gantacurium-induced neuromuscular block is possible with administration of cysteine . This first drug in class showed promising results in animal and human studies which will be discussed.