Adverse Effects and Precautions

d-Tubocurarine may cause bronchospasms and hypotension by release of histamine from mast cells. This may be counteracted by prior treatment with antihista-mines. d-Tubocurarine produces partial block of sympathetic ganglia and the adrenal medulla, which may also contribute to hypotension.

Inhalation anesthetics, such as isoflurane, enflurane, halothane, and nitrous oxide, potentiate the action of nondepolarizing blockers, either through modification of end plate responsiveness or by alteration of local blood flow. The extent of potentiation depends on the anesthetic and the depth of anesthesia. The dose of muscle relaxant should be reduced when used with these anesthetics.

Certain antibiotics (e.g., aminoglycosides, macrolides, polymyxins, lincomycin) enhance neuromuscular blockade by either decreasing ACh release or blocking the postjunctional response. Procainamide and phenytoin also increase the effects of d-tubocurarine-like drugs. The amount of neuromuscular blocker should be decreased accordingly.

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