Atracurium stereoisomers

Atracurium has several stereoisomers, and the potent isomer cisatracurium has become one of the most commonly used muscle relaxants in clinical practice. Although cisatracurium resembles atracurium, it has less dependence on hepatic inactivation, produces less laudanosine, and is less likely to release histamine. From the clinical perspective, cisatracurium has all the advantages of atracurium with fewer side effects. Therefore, cisatracurium has largely replaced atracurium in clinical practice. 

Cisatracurium is a stereoisomer of atracurium it is less prone to cause histamine release. 

To counter the problems produced by laudanosine, the stereoisomers of atracurium were isolated in order to allow a dose reduction. Cisatracurium (Fig. 16.24) is an... 

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