Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

dantrolene (Rx)Brand and Other Names:Dantrium, Revonto, more...Ryanodex

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 25mg
  • 50mg
  • 100mg

powder for injection

  • 20mg/vial (Dantrium, Revonto)
  • 250mg/vial (Ryanodex)
more...

Malignant Hyperthermia (Per MHAUS)

2.5 mg/kg rapid IV bolus, repeat PRN 

Sometimes >10 mg/kg (cumulative dose) is necessary (up to 30 mg/kg)

Maintenance: 1 mg/kg IV q4-6hr OR 0.25 mg/kg/hr IV infusion

Continue at least for 36 hr

MHAUS: Malignant Hyperthermia Association of the United States, guideline 2008

Malignant Hyperthermia, Prevention

NOT recommended by MHAUS

1-3 days before surgery: 4-8 mg/kg/day PO divided q6hr 

75 minutes before anesthesia: 2.5 mg/kg IV once over 60 minutes; administer additional doses PRN

Spasticity

25 mg PO qDay for 7 days, THEN

25 mg PO q8hr for 7 days, THEN

50 mg PO q8hr for 7 days, THEN

100 mg PO q8hr, not to exceed 100 mg PO q6hr

Discontinued if no benefits within 6-7 weeks

Neuroleptic Malignant Syndrome (Off-label)

25 mg/day IV; gradually increase to 150 mg/day

Succinylcholine-induced Fasciculations & Post-op Muscle Pain (Off-label)

<45 kg: 100 mg PO 2 hr pre-op

≥45 kg: 150 mg PO 2 hr pre-op

Monitor: LFTs, bilirubin

Wolfram Syndrome (Orphan)

Orphan designation for treatment of Wolfram Syndrome

Sponsor

  • Washington University in St. Louis; 660 S. Euclid Avenue, Campus Box 8127; St. Louis, Missouri 63110

Other Indications & Uses

Off-label: Muscle pain in Duchenne muscular dystrophy, muscle pain in phosphorylase deficiency (exercise), to reduce succinylcholine-induced fasciculations & post-op muscle pain, NMS

Dosage Forms & Strengths

capsule

  • 25mg
  • 50mg
  • 100mg

powder for injection

  • 20mg/vial (Dantrium, Revonto)
  • 250mg/vial (Ryanodex)
more...

Malignant Hyperthermia (Per MHAUS)

2.5 mg/kg rapid IV bolus, repeat PRN 

Sometimes >10 mg/kg (cumulative dose) is necessary (up to 30 mg/kg)

Maintenance: 1 mg/kg IV q4-6hr OR 0.25 mg/kg/hr IV infusion

Continue at least for 36 hr

MHAUS: Malignant Hyperthermia Association of the United States, guideline 2008

Malignant Hyperthermia, Prevention

NOT recommended by MHAUS

1-3 days before surgery: 4-8 mg/kg/day PO divided q6hr 

75 minutes before anesthesia: 2.5 mg/kg IV once over 60 minutes; administer additional doses PRN

Spasticity

Monitor: LFTs, bilirubin

≥5 Years

  • 0.5 mg/kg PO qDay for 7 days, THEN 
  • 0.5 mg/kg PO q8hr for 7 days, THEN
  • 1 mg/kg PO q8hr for 7 days, THEN
  • 2 mg/kg PO q8hr, not to exceed 100 mg PO q6hr

<5 Year

  • Initial: 1 mg/kg/day PO divided q12hr
  • Maximum maintenance: 12 mg/kg/day PO divided q6hr
  • Not to exceed 3 mg/kg PO q6-12hr OR 400 mg/24 hr PO

See adult dosing

Spontaneous reports suggest a higher proportion of hepatic events with fatal outcome in elderly patients

Next

Interactions

Interaction Checker

dantrolene and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            Frequency Not Defined

            Increased serum AST (SGOT), ALT (SGPT), alkaline phosphatase, LDH, BUN, and total serum bilirubin concentrations

            Fatal/nonfatal hepatitis

            Diarrhea

            Anorexia

            Nausea

            Vomiting

            Gastric irritation

            Abdominal cramps

            Constipation

            Dysphagia

            GI bleeding

            Adynamic ileus

            Speech disturbance

            Headache

            Visual disturbances

            Dysgeusia

            Mental depression

            Confusion

            Auditory/visual hallucinations

            Increased nervousness

            Insomnia

            Drooling

            Exacerbation/precipitation of seizures

            Muscle weakness

            Drowsiness

            Dizziness

            Urinary frequency/incontinence

            Nocturia

            Difficult urination/urinary retention

            Crystalluria, hematuria

            Difficult erection

            Abnormal hair growth

            Acneiform rash

            Eczematoid eruption

            Pruritus, urticaria

            Sweating

            Tachycardia

            Erratic blood pressure

            Phlebitis

            Heart failure

            Aplastic anemia

            Anemia

            Leukopenia

            Lymphocytic

            Lymphoma

            Thrombocytopenia

            Respiratory depression

            Pleural effusion with associated eosinophilia

            Previous
            Next

            Warnings

            Black Box Warnings

            The incidence of symptomatic (fatal and nonfatal) hepatitis is lower with doses up to 400 mg daily compared to >800 mg daily

            Overt hepatitis has been most frequently observed during third and twelfth months, but may occur at anytime. Risk higher in females and patients >35 years, and with concurrent therapy

            Use only in conjunction with liver monitoring

            Should not be used in conditions other than those recommended; discontinue therapy if benefits not observed within 45 days in chronic spasticity

            Contraindications

            NO CONTRAINDICATIONS for IV use in MH management/prophylaxis

            Hypersensitivity

            Impaired hepatic, cardiac or pulmonary function

            Upper motor neuron disorder

            Patients in whom spasticity is utilized to maintain upright posture & balance

            Cautions

            Possibility of severe hepatotoxicity

            Risk of muscle weakness

            Risk of photosensitivity reactions

            Females, >35 years, receiving other drugs, history of liver disease

            Not indicated in muscle spasms due to rheumatic disorder or musculoskeletal trauma

            Ineffective in ALS

            Use caution when administering oral therapy in patients with severely impaired cardiac function resulting from myocardial disease

            Use caution when administering oral therapy in patients with impaired pulmonary function

            In combination with calcium channel blockers IV dantrolene may increase risk for hyperkalemia and cardiac arrest (combination not recommended)

            Severely impaired cardiac function due to myocardial disease

            Associated with pleural effusion with associated eosinophilia

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk/not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Interferes with calcium release within skeletal muscle cells (from sarcoplasmic reticulum)

            Pharmacokinetics

            Peak plasma time: 5 hr

            Concentration: 100 to >600 ng/mL

            Half-life elimination: 4-8hr

            Duration: 3 hr or longer

            Protein Bound: substantial

            Metabolism: Liver

            Metabolites: 5-hydroxy derivative

            Excretion: Urine (25%); feces (45-50%)

            Previous
            Next

            Administration

            IV Compatibilities

            Sterile water for injection (SWI)

            IV Incompatibilities

            Dextrose solutions

            0.9% NaCl

            Other acidic solutions

            IV Preparation

            Ryanodex

            • Reconstitute each 250 mg vial by adding 5 mL of SWI (not bacteriostatic water for injection)
            • Shake the vial to ensure an orange-colored uniform suspension Visually inspect the vial for particulate matter and discoloration prior to administration

            Dantrium, Revonto

            • Reconstitute each 20 mg vial by adding 60 mL of SWI (not bacteriostatic water for injection)
            • Shake vial for about 20 seconds or until solution is clear
            • Do not transfer reconstituted solutions to large glass bottles for prophylactic infusion due to precipitate formation
            • May transfer to larger volume sterile IV empty plastic bag

            IV Administration

            Therapeutic or emergency dose can be administered with rapid IV push

            Follow-up doses should be administered over 2-3 min

            36 vials (20 mg/vial) are needed for adequate hyperthermia therapy

            Ryanodex

            • Administer the reconstituted suspension either:
            • -Into the IV catheter while an IV infusion of 0.9% NaCal or 5% dextrose injection is freely running; or
            • -Into the indwelling catheter after assuring its patency without a freely running infusion
            • Flush the IV line to assure that there is no residual drug that remains in the catheter

            Storage

            Unreconstituted vials

            • Store controlled room temperature 20-25° C (68-77° F)
            • Avoid prolonged exposure to light

            Reconstituted vials

            • Should be used immediately, but reconstituted solution may be stored at controlled room temperature 20-25° C (68-77° F) and used within 6 hr
            • Protect from direct light
            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.