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cisatracurium (Nimbex)
Tradename: Nimbex. (cisatracurium besylate)
Indications:
1) neuromuscular blockade in patients with renal insufficiency &/or hepatic insufficiency
2) eases endotracheal intubation
3) adjunctive agent to general anesthesia
4) relaxation of skeletal muscle during mechanical ventilation
Contraindications: Caution:
1) may produce profound effects in patients with neuromuscular disorders (i.e. myasthenia gravis)
2) patients with severe burns may develop resistance
3) maintenance of adequate airway & ventilatory support is necessary
4) multidose vial contains benzyl alcohol
Dosage:
1) 0.1-0.2 mg/kg IV bolus, then
2) 3 ug/kg/min, titrate to train of 4
3) infuse in D5W or normal saline
4) NOT compatible with lactated Ringer's (LR)
5) no dosage adjustiment with renal insufficiency or hepatic insufficiency
Injection: 2 mg/mL (5 & 10 mL); 10 mg/mL (20 mL).
Pharmacokinetics:
- Duration: 30-60 minutes.
Adverse effects:
- uncommon (< 1%) (generally minimal & transient)
- bradycardia, hypotension, flush, rash, bronchospasm
Overdose:
1) respiratory depression, cardiovascular collapse
2) neostigmine 1-3 mg IV push (adults), 0.5 mg (children) with or immediately after atropine 1.0-1.5 mg IV (adults)
Drug interactions:
1) agents that prolong neuromuscular blockade
- inhalation anesthetics
- halothane (marginal)
- reduce dosage by 30-40% in patients receiving enflurane or isoflurane
- local anesthetics
- lithium carbonate
- Mg+2 salts
- antiarrhythmic agents: quinidine, procainamide
- antibiotics:
- aminoglycosides, tetracyclines, vancomycin, clindamycin
2) resistance to neuromuscular blockade
- chronic phenytoin or carbamazepine
Mechanism of action:
1) neuromuscular blocking agent
2) does not relieve pain
Interactions
drug interactions
Related
atropine (Atropair, Atropine-Care)
neostigmine (Prostigmin)
General
neuromuscular blocker (paralyzing agent)
Properties
MISC-INFO: elimination route PLASMA
pregnancy-category B
safety in lactation ?
Database Correlations
PUBCHEM cid=62886
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Department of Veterans Affairs, VA National Formulary