Selective relaxant binding agents

Selective relaxant binding agents (SRBAs) are a new class of drugs that selectively encapsulates and binds neuromuscular blocking agents (NMBAs). The first drug introduction of an SRBA is sugammadex. SRBAs exert a chelating action that effectively terminates an NMBA ability to bind to nicotinic receptors.

Examples of SRBAs include:

1. Sugammadex is a modified gamma cyclodextrin that specifically encapsulates and binds the aminosteroid NMBAs: affinity is highest for rocuronium, followed by vecuronium, and relatively low affinity for pancuronium.

2. Adamgammadex is also a modified gamma-cyclodextrin, with acetyl-amino groups replacing the carboxylic acid groups of sugammadex. Early research suggests it may have a lower incidence of adverse reactions than sugammadex

3. Calabadion 1 and calabadion 2 are cucurbituril molecules with high binding affinity for both aminosteroid and benzylisoquinoline muscle relaxants. Calabadion 2 has 89 times the affinity for rocuronium than does sugammadex.

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