Classes
DEA Class; Rx
Common Brand Names; Nimbex
- Neuromuscular Blockers, Nondepolarizing
Description
Parenteral, intermediate-acting, nondepolarizing, neuromuscular blocking agent (NMBA)
Used for an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation
Minimal histamine release
Indications
Indicated for muscluar relaxation during non-emergent endotracheal intubation.
For neuromuscular blockade during mechanical ventilation in intensive care patients.
For neuromuscular blockade during surgery.
Contraindications
Hypersensitivity to cisatracurium (or benzyl alcohol if 10 mL vial is used)
Use of 10 mL vial in pediatric patients <1 month of age and low birth-weight infants (contains benzyl alcohol)
Adverse Effects
- Bronchospasm
- Bradycardia
- Flushing
- Pruritus
- Myositis ossificans
- Hypotension
- Rash
- Anaphylaxis
- Histamine release
- Prolonged neuromuscular block
- Muscle weakness, myopathy
Warnings
Laudanosine, an active metabolite, reported to cause seizures in animals; patients with renal or hepatic impairment receiving extended therapy may be at higher risk of seizures; monitor level of neuromuscular blockade during long-term administration to limit exposure to toxic metabolites
Severe anaphylactic reactions to neuromuscular blocking agents have been reported; some cases have been life threatening and fatal; take necessary precautions, such as the immediate availability of appropriate emergency treatment
Confirm proper selection of intended product and avoid confusion with other injectable solutions that are present in critical care and other clinical settings; ensure that the intended dose is clearly labeled and communicated when another healthcare provider is administered
Neuromuscular blockade in the conscious patient can lead to distress; use drug in presence of appropriate sedation or general anesthesia and monitor patients to ensure level of anesthesia is adequate
Pregnancy and Lactation
There are no adequate and well-controlled studies in pregnant women
The 10 mL multiple-dose vials contain the preservative benzyl alcohol; if therapy is needed during lactation, consider using a benzyl alcohol-free formulation (ie, 5 mL and 20 mL single-dose vials)
Maximum Dosage
How supplied
Cisatracurium besylate
injectable solution
2mg/mL (multidose vial)
Contains benzyl alcohol
injectable solution, preservative free
2mg/mL (single-dose vial)
10mg/mL (single-dose vial)
