A molecule of gantacurium


Gantacurium is a rapid onset ultrashort duration nondepolarizing neuromuscular blocking agent that might be released in the future. It is currently in Stage III clinical development. If it passes, it will likely be extremely successful and popular, possibly replacing succinylcholine (How many drugs have tried to replace succinylcholine now?). It's a tough challenge, but gantacurium may be up to it.

Gantacurium is only a single isomer, is asymmetrical, unlike all the other "curiums", and it has what is called a chlorofumarate. A fumarate group is the thing in the middle of its structure that kind of looks like succinic acid but with a double bond. The chlorine atom attached makes it a chlorofumarate.

What's neat is, in the Kreb's cycle in cellular respiration, as part of the cycle, succinate (like what is in succinylcholine) is transformed into fumarate (like what is in gantacurium). So if gantacurium replaces succinylcholine, the progression of development of neuromuscular blocking agents could also be like a representation of the natural cycle of cellular respiration. It's cool how things connect and align like that.