Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Succinylcholine Anectine · Quelicin	Rocuronium Zemuron	Cisatracurium Nimbex
Class	Depolarizing neuromuscular blocker	Aminosteroid non-depolarizing muscle relaxant	Benzylisoquinolinium non-depolarizing neuromuscular blocker (intermediate duration)
Mechanism	Acetylcholine receptor agonist at the NMJ; sustained depolarization → fasciculations → flaccid paralysis. Hydrolyzed by plasma cholinesterase.	Competitive antagonist at the NMJ nicotinic receptor.	Competitive antagonist at the post-synaptic nicotinic ACh receptor at the neuromuscular junction. Single cis-cis isomer of atracurium (4× more potent, lower laudanosine production).
Indications	· RSI · Laryngospasm rescue · ECT (modify motor seizure) · Brief paralysis	· RSI alternative to sux · Maintenance paralysis · ICU paralysis	· Neuromuscular blockade for intubation + maintenance · Preferred when renal/hepatic dysfunction, patients without IV access for sugammadex, organ donor procurement
Dosing	RSI: 1–1.5 mg/kg IV · peds 2 mg/kg IV (ages 2+); up to 3 mg/kg IV in infants <2 yr; 4 mg/kg IM single dose (max 150 mg) Laryngospasm: 0.1–0.5 mg/kg IV; 4 mg/kg IM if no IV	Intubation: 0.6 mg/kg IV (90 sec onset) · peds 0.6 mg/kg IV RSI dose: 1.0–1.2 mg/kg IV (60 sec onset) · peds 1.0–1.2 mg/kg IV (rescue with sugammadex 16 mg/kg if cannot intubate/ventilate) Maintenance: 0.1–0.2 mg/kg q30 min or 8–10 mcg/kg/min	Intubation (2× ED95): 0.15–0.20 mg/kg IV · peds 0.10–0.15 mg/kg IV (age 2–12) Maintenance bolus: 0.03 mg/kg IV q20–30 min Continuous infusion: 1–3 mcg/kg/min after recovery to T1 · peds 1.0–2.0 mcg/kg/min
PK (onset / duration)	Onset 30–60 sec. Duration 5–10 min. Plasma pseudocholinesterase metabolism.	Onset 60–90 sec (dose-dependent). Duration 30–45 min (intubation dose). Hepatic uptake + biliary > renal elimination.	Onset 2–3 min (slower than rocuronium 1–2 min). Duration of intubating dose ~45–60 min. Eliminated by HOFMANN ELIMINATION (spontaneous, pH+temperature-dependent breakdown in plasma at body pH/37°C). Independent of hepatic + renal clearance — the unique property that drives ICU + organ-failure use. Hofmann produces laudanosine (CNS stimulant at very high cumulative doses; clinically irrelevant with cis vs older atracurium).
Hemodynamics	—	Minimal (vagolytic at high doses).	Hemodynamically inert at clinical doses — no significant histamine release (unlike older atracurium), no autonomic effects, no HR/BP changes. The cleanest cardiovascular profile of any NMB.
Respiratory	—	—	—
Side effects	· Hyperkalemia (↑0.5 mEq/L normally; severe in burns > 24 h, denervation, prolonged immobility, MS, ALS, Guillain-Barré) · Bradycardia/arrhythmia (especially repeat dose, peds — pretreat with atropine) · Masseter rigidity (may herald MH) · Postoperative myalgia · ↑ICP, ↑IOP, ↑intragastric pressure	· Anaphylaxis (~1:2,500) · Prolongation in hepatic dysfunction	· Slower onset than rocuronium (not preferred for true RSI) · No sugammadex reversal — must wait for spontaneous recovery or use neostigmine · Laudanosine accumulation with very prolonged infusions (days) — theoretical seizure risk, not seen clinically with cis · Slight precipitation with alkaline drugs (propofol) — flush line between
Contraindications	· Personal/family hx malignant hyperthermia · Hyperkalemia · Burns > 24 h, denervation injury, prolonged immobility (upregulated extrajunctional ACh receptors) · Open globe injury (relative)	· Known anaphylaxis to roc/vec	· Known hypersensitivity (rare)
Reversal	Wait it out (5–10 min); no pharmacologic reversal. Prolonged block from pseudocholinesterase deficiency: continue ventilation until block resolves (FFP not standard).	Sugammadex 2–4 mg/kg (TOF reversal) or 16 mg/kg (immediate full reversal). Neostigmine works once T1 > 25%.	Neostigmine 0.04–0.07 mg/kg IV + glycopyrrolate 0.01 mg/kg (or atropine) once TOF count ≥ 2/4. Sugammadex DOES NOT reverse cisatracurium (only aminosteroids: roc, vec, panc).
Pearls	· Always have atropine drawn for peds doses > 0.5 mg/kg. · Phase II block can mimic non-depolarizing block at high cumulative doses. · Defasciculation pretreatment of NDMR ↓ myalgia, ↑ sux dose required by 70%.	· 1.2 mg/kg + sugammadex 16 mg/kg = sux-comparable RSI option without K⁺ risk. · Less hepatic metabolism than vecuronium → preferred in ESRD. · Wait for ≥2 twitches before extubation; quantitative TOF preferred (TOFR ≥ 0.9).	· Drug of choice when both renal AND hepatic function are impaired or unknown (organ failure ICU patient, transplant recipient, sepsis with multi-organ dysfunction). · Hofmann elimination: NMB clearance unaffected by perfusion, hepatic blood flow, dialysis status — predictable offset. · ED95 ~0.05 mg/kg; intubating dose is 2–4× ED95; bolus + infusion strategy avoids histamine that older atracurium produced. · Stored refrigerated (4°C); discard if shaken vigorously or warmed > 25°C × prolonged period (Hofmann begins in the syringe).

Common compares

Propofol vs Etomidate vs Ketamine Sux vs Roc vs Cis Fentanyl vs Remi Phenylephrine vs Norepi Volatiles

Cells showing "—" indicate the drug doesn't have a detail entry for that field yet (most drugs do; some legacy class members haven't been fully populated). Education only — verify dosing against package insert + institutional protocol before bedside use.

Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Succinylcholine Anectine · Quelicin	Rocuronium Zemuron	Cisatracurium Nimbex
Class	Depolarizing neuromuscular blocker	Aminosteroid non-depolarizing muscle relaxant	Benzylisoquinolinium non-depolarizing neuromuscular blocker (intermediate duration)
Mechanism	Acetylcholine receptor agonist at the NMJ; sustained depolarization → fasciculations → flaccid paralysis. Hydrolyzed by plasma cholinesterase.	Competitive antagonist at the NMJ nicotinic receptor.	Competitive antagonist at the post-synaptic nicotinic ACh receptor at the neuromuscular junction. Single cis-cis isomer of atracurium (4× more potent, lower laudanosine production).
Indications	· RSI · Laryngospasm rescue · ECT (modify motor seizure) · Brief paralysis	· RSI alternative to sux · Maintenance paralysis · ICU paralysis	· Neuromuscular blockade for intubation + maintenance · Preferred when renal/hepatic dysfunction, patients without IV access for sugammadex, organ donor procurement
Dosing	RSI: 1–1.5 mg/kg IV · peds 2 mg/kg IV (ages 2+); up to 3 mg/kg IV in infants <2 yr; 4 mg/kg IM single dose (max 150 mg) Laryngospasm: 0.1–0.5 mg/kg IV; 4 mg/kg IM if no IV	Intubation: 0.6 mg/kg IV (90 sec onset) · peds 0.6 mg/kg IV RSI dose: 1.0–1.2 mg/kg IV (60 sec onset) · peds 1.0–1.2 mg/kg IV (rescue with sugammadex 16 mg/kg if cannot intubate/ventilate) Maintenance: 0.1–0.2 mg/kg q30 min or 8–10 mcg/kg/min	Intubation (2× ED95): 0.15–0.20 mg/kg IV · peds 0.10–0.15 mg/kg IV (age 2–12) Maintenance bolus: 0.03 mg/kg IV q20–30 min Continuous infusion: 1–3 mcg/kg/min after recovery to T1 · peds 1.0–2.0 mcg/kg/min
PK (onset / duration)	Onset 30–60 sec. Duration 5–10 min. Plasma pseudocholinesterase metabolism.	Onset 60–90 sec (dose-dependent). Duration 30–45 min (intubation dose). Hepatic uptake + biliary > renal elimination.	Onset 2–3 min (slower than rocuronium 1–2 min). Duration of intubating dose ~45–60 min. Eliminated by HOFMANN ELIMINATION (spontaneous, pH+temperature-dependent breakdown in plasma at body pH/37°C). Independent of hepatic + renal clearance — the unique property that drives ICU + organ-failure use. Hofmann produces laudanosine (CNS stimulant at very high cumulative doses; clinically irrelevant with cis vs older atracurium).
Hemodynamics	—	Minimal (vagolytic at high doses).	Hemodynamically inert at clinical doses — no significant histamine release (unlike older atracurium), no autonomic effects, no HR/BP changes. The cleanest cardiovascular profile of any NMB.
Respiratory	—	—	—
Side effects	· Hyperkalemia (↑0.5 mEq/L normally; severe in burns > 24 h, denervation, prolonged immobility, MS, ALS, Guillain-Barré) · Bradycardia/arrhythmia (especially repeat dose, peds — pretreat with atropine) · Masseter rigidity (may herald MH) · Postoperative myalgia · ↑ICP, ↑IOP, ↑intragastric pressure	· Anaphylaxis (~1:2,500) · Prolongation in hepatic dysfunction	· Slower onset than rocuronium (not preferred for true RSI) · No sugammadex reversal — must wait for spontaneous recovery or use neostigmine · Laudanosine accumulation with very prolonged infusions (days) — theoretical seizure risk, not seen clinically with cis · Slight precipitation with alkaline drugs (propofol) — flush line between
Contraindications	· Personal/family hx malignant hyperthermia · Hyperkalemia · Burns > 24 h, denervation injury, prolonged immobility (upregulated extrajunctional ACh receptors) · Open globe injury (relative)	· Known anaphylaxis to roc/vec	· Known hypersensitivity (rare)
Reversal	Wait it out (5–10 min); no pharmacologic reversal. Prolonged block from pseudocholinesterase deficiency: continue ventilation until block resolves (FFP not standard).	Sugammadex 2–4 mg/kg (TOF reversal) or 16 mg/kg (immediate full reversal). Neostigmine works once T1 > 25%.	Neostigmine 0.04–0.07 mg/kg IV + glycopyrrolate 0.01 mg/kg (or atropine) once TOF count ≥ 2/4. Sugammadex DOES NOT reverse cisatracurium (only aminosteroids: roc, vec, panc).
Pearls	· Always have atropine drawn for peds doses > 0.5 mg/kg. · Phase II block can mimic non-depolarizing block at high cumulative doses. · Defasciculation pretreatment of NDMR ↓ myalgia, ↑ sux dose required by 70%.	· 1.2 mg/kg + sugammadex 16 mg/kg = sux-comparable RSI option without K⁺ risk. · Less hepatic metabolism than vecuronium → preferred in ESRD. · Wait for ≥2 twitches before extubation; quantitative TOF preferred (TOFR ≥ 0.9).	· Drug of choice when both renal AND hepatic function are impaired or unknown (organ failure ICU patient, transplant recipient, sepsis with multi-organ dysfunction). · Hofmann elimination: NMB clearance unaffected by perfusion, hepatic blood flow, dialysis status — predictable offset. · ED95 ~0.05 mg/kg; intubating dose is 2–4× ED95; bolus + infusion strategy avoids histamine that older atracurium produced. · Stored refrigerated (4°C); discard if shaken vigorously or warmed > 25°C × prolonged period (Hofmann begins in the syringe).