Competitive Nondepolarizing Agents and Antagonists
Drug | Dosage |
|---|---|
Nondepolarizing Agents | |
Atracurium | Dogs: 0.2–0.5 mg/kg, IV as bolus; 4–9 mcg/kg/min, IV as CRI1,2 Cats: 0.2 mg/kg, IV3 Horses: 0.1–0.2 mg/kg, IV as bolus; 0.2 mg/kg/h, IV as CRI4 |
Cisatracurium | Dogs and cats: 0.1–0.15 mg/kg, IV5,6 Horses: 0.05–0.1 mg/kg, IV7 |
Rocuronium | Dogs: 0.4–0.6 mg/kg, IV8,9 Cats: 0.3–0.6 mg/kg, IV10,11 Horses: 0.2–0.4 mg/kg, IV12 |
Vecuronium | Dogs: 0.05–0.1 mg/kg, IV13 Cats: 0.05–0.1 mg/kg, IV14 |
Antagonists | |
Edrophonium | Dogs and cats: 0.1–0.5 mg/kg, IV; may be combined with an anticholinergic (atropine at 0.02–0.04 mg/kg, IV, or glycopyrrolate at 0.01 mg/kg, IV) to avoid muscarinic effects15 Horses: 0.1–0.5 mg/kg, IV slowly over 1–2 min; the infusion should be stopped or an anticholinergic administered (atropine at 0.02–0.04 mg/kg, IV) if the horse develops bradycardia or hypotension during administration15 |
Neostigmine | Dogs and cats: 0.02–0.04 mg/kg, IV, combined with or preceded by an anticholinergic (atropine at 0.02–0.04 mg/kg, IV, or glycopyrrolate at 0.01 mg/kg, IV) to avoid muscarinic effects15 |
Sugammadex | Dogs and cats: 1.0–4.0 mg/kg, IV17,18 Horses: 0.5–2.0 mg/kg, IV19 |
1Martínez CS, Redondo JI, Rioja E. Comparison of two atracurium dosing regimens in dogs undergoing ophthalmic surgery. Vet Anaesth Analg. 2026;53(2):101188. doi:10.1016/j.vaa.2026.101188 2Macintire DK, Drobatz KJ, Haskins SC, Saxon WD. Drug formulary. In: Macintire DK, Drobatz KJ, Haskins SC, Saxon WD, eds. Manual of Small Animal Emergency and Critical Care Medicine. 2nd ed. John Wiley & Sons; 2012:524-651. doi:10.1002/9781119421870.app10 3Papastefanou A, Parsons E, Rioja, E. Reduction of train-of-four ratio following low dose neostigmine reversal of atracurium in a cat. Vet Anaesth Analg. 2022;49(2):222-224. doi:10.1016/j.vaa.2021.10.006 4Hildebrand SV, Bolich JA. Clinical use of atracurium in large animal species. Vet Anaesth Analg. 2002;29(2):108. doi:10.1046/j.1467-2995.2002.00078_27.x 5Ida KK, Van-Wijnsberghe AS, Tutunaru A, et al. Onset and duration of cis-atracurium neuromuscular block during fentanyl and lidocaine infusions in isoflurane-anaesthetised dogs. Vet Rec. 2020;187(5):e33. doi:10.1136/vr.105522 6Van Wijnsberghe AS, Ida KK, Dmitrovic P, Tutunaru A, Sandersen C. Neuromuscular blockade effects of cisatracurium in 11 cats undergoing ophthalmological surgery anaesthetised with isoflurane. J Feline Med Surg. 2022;24(4):402-406. doi:10.1177/1098612X211021829 7Tutunaru A, Dupont J, Gougnard A, Ida K, Serteyn D, Sandersen C. Retrospective evaluation of clinical use of cis-atracurium in horses. PLoS One. 2019;14(8):e0221196. doi:10.1371/journal.pone.0221196 8Dugdale AH, Adams WA, Jones RS. The clinical use of the neuromuscular blocking agent rocuronium in dogs. Vet Anaesth Analg. 2002;29(1):49-53. doi:10.1046/j.1467-2987.2001.00057.x 9Martin-Flores M, Hackman MC, Araos JD, Campoy L, Gleed RD. Duration of neuromuscular block is more variable and recovery time is shorter with rocuronium than cisatracurium in anesthetized dogs. Vet Ophthalmol. 2023;26(5):407-413. doi:10.1111/vop.13074 10Sakai DM, Zornow KA, Campoy L, et al. Intravenous rocuronium 0.3 mg/kg improves the conditions for tracheal intubation in cats: a randomized, placebo-controlled trial. J Feline Med Surg. 2018;20(12):1124-1129. doi:10.1177/1098612X18754425 11Martin-Flores M, Sakai DM, Portela DA, Borlle L, Campoy L, Gleed RD. Prevention of laryngospasm with rocuronium in cats: a dose-finding study. Vet Anaesth Analg. 2016;43(5):511-518. doi:10.1111/vaa.12342 12Kodaira K, Kakizaki M, Nagata SI, et al. Pharmacodynamics and pharmacokinetics of rocuronium in sevoflurane-anesthetized Thoroughbred horses. Vet Anaesth Analg. 2025;52(2):174-182. doi:10.1016/j.vaa.2024.12.006 13Martin-Flores M, Lorenzutti AM, Litterio NJ, et al. Speed of reversal of vecuronium neuromuscular block with different doses of neostigmine in anesthetized dogs. Vet Anaesth Analg. 2017;44(1):28-34. doi:10.1111/vaa.12395 14Martin-Flores M, Sakai DM. Neuromuscular blocking agents. In: Aarnes T, Lerche P, eds. Pharmacology in Veterinary Anesthesia and Analgesia. John Wiley & Sons; 2024:202-214. doi:10.1002/9781118975169.ch16 15Jones RS, Auer U, Mosing M. Reversal of neuromuscular block in companion animals. Vet Anaesth Analg. 2015;42(5),455-471. doi:10.1111/vaa.12272 16Lorenzutti AM, Martin-Flores M, Baldivieso JM, Himelfarb MA, Litterio NJ. Evaluation of neostigmine antagonism at different levels of vecuronium-induced neuromuscular blockade in isoflurane anesthetized dogs. Can Vet J. 2014;55(2):156-160. https://pmc.ncbi.nlm.nih.gov/articles/PMC3894876 17Martin-Flores M, Lorenzutti AM, Markmann AD, Araos J, Campoy L. Speed of reversal by sugammadex or neostigmine after vecuronium-induced neuromuscular block in dogs: randomized clinical trial and pharmacological modeling. Vet Anaesth Analg. 2025;52(3):328-337. doi:10.1016/j.vaa.2025.03.004 18Cesnik NM, D'Angelo Campos K, Cavaco JS, et al. Dose–response evaluation of sugammadex for reversal of deep rocuronium-induced neuromuscular block in cats. Vet Sci. 2025;12(12):1135. doi:10.3390/vetsci12121135 19Martin-Flores M, Sakai DM, Araos J, Campoy L. Low-dose sugammadex reverses moderate rocuronium-induced neuromuscular block in horses. Equine Vet J. 2025;57(1):265-270. doi:10.1111/evj.14066 | |
