An Assessment of Flaxedil (Gallamine Triethiodide, B.P.)

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Abstract
Flaxedil is a synthetic curarizing agent first synthesized in France. It is effectively counteracted by neostigmine and its period of action is shorter than that of tubocurarine. Exptl. evidence is presented to show that Flaxedil is excreted more quickly than tubocurarine. In volunteers 40-70 mg. of Flaxedil could be tolerated without demonstrable decrease in pulmonary ventilation. In 243 operative cases the equivalent dosages of the 3 relaxants needed to produce an easy intubation were 80 mg. of Flaxedil, 20 mg. of tubocurarine and 4 mg. of decamethonium iodide. The effect on respiration was considerably less with Flaxedil than with the other drugs. A disadvantage of Flaxedil is that it induces tachycardia. In the above series it produced an increase in pulse rate occurred in every case without arrhythmia. The onset of tachycardia was practically immediate and coincident with the onset of curarizing effect. It occurred in some degree at all doses. The effect of neostigmine, even though buffered with atropine, was to produce an immediate decrease in pulse rate. Animal expts. on cats and rabbits suggested that the tachycardia was due to vagal block unaccompanied by sympathetic block. Flaxedil, therefore, may not be the relaxant of choice in prolonged major surgery in patients with pre-existing cardiac disease. Flaxedil is excreted unchanged by the kidney. An adequate renal function is a prerequisite for its use. The greater proportion of a given dose is eliminated within 2 hrs. There have been no cases of sensitivity reported. There may be a cumulative effect. From a clinical standpoint, Flaxedil has 4 distint advantages over tubocurarine: there is a greater margin between muscular relaxation and diaphragmatic paralysis; Flaxedil has an equally effective but shorter period of action; its action is more readily and rapidly reversed by neostigmine; and it does not lower the blood pressure. It is concluded that Flaxedil is a very safe and versatile muscle relaxant.