Acetylcholinesterase bisquaternary

Pipecuronium bromide is a bisquaternary steroid analogue of pancuronium. In vitro pipecuronium reversibly inhibits both human red cell acetylcholinesterase and human plasma cholinesterase to an extent that might have clinical implications (1). Its potency is similar to that of pancuronium and its onset and duration are also approximately the same. Accumulation can occur (2), and maintenance doses should be one-quarter to one-sixth of the initial dose to achieve a similar effect, depending on the anesthetic technique used. 

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Luo C, Ashani Y and Doctor BP (1998a). Acceleration of oxime-induced reactivation of organophosphate -inhibited fetal bovine serum acetylcholinesterase by monoquaternary and bisquaternary ligands. Mol Pharmacol, 53, 718-726. 

Kuca, K., Cabal, J., Patocka, J., et al., 2004a. Synthesis of bisquaternary symmetric—X/ t)is(2-hydroxyiminomethyl-pyridinium)alkane dibromides and their reactivation of cyclosarin-inhibited acetylcholinesterase. Lett. Org. Chem. 1, 84-86. 

Musilek, K., Komloova, M., Holas, O., et al., 2011b. Mono-oxime bisquaternary acetylcholinesterase reactivators with prop-l,3-diyl linkage-preparation, in vitro screening and molecular docking. Bioorg. Med. Chem. 19, 754-762. 

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