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Cisatracurium and mivacurium are widely used neuromuscular blocking drugs. Previous reports have indicated growth-inhibitory effects of cisatracurium, but not mivacurium, on two human cell lines in vitro. These effects were ascribed to oxidative stress elicited by acrylate esters formed during cisatracurium breakdown. The aim of the present study was to investigate whether these agents would possibly interfere with the peripheral nervous system. Survival and axonal growth of rat primary neurons obtained from the superior cervical sympathetic ganglion (SCG) or from the adult dorsal root ganglion (DRG) were investigated after treatment with cisatracurium or mivacurium at concentrations from 1 to 10 microM for 24 h. Cisatracurium, but not mivacurium, significantly decreased neuronal survival in a dose-dependent manner, and axonal length was considerably reduced by cisatracurium as compared to controls. It is concluded that high concentrations of cisatracurium are potentially neurotoxic.