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It is metabolized by liver and kidney so to be avoided in preexisting hepatic and renal disorder. Hepatic and Renal failure , the neuromuscular blocker of choice is Atracurium and Cisatracurium Cis-atracurium undergoes Hofmann elimination - which is spontaneous non-enzymatic degradation. So renal failure doesn't affect the clearance of cis atracurium. Hence it is the agent of choice in renal failure patients. Atracurium also undergo Hofmann elimination and so is an alternative to cis atracurium in renal failure. Steroidal muscle relaxants are predominantly eliminated by ultrafiltration by the glomeruli before urinary excretion. Doxacurium, pancuronium, and pipecuronium are paially excreted by the kidneys, and so the neuromuscular block is prolonged in patients with renal failure.