cisatracurium (Rx)

Brand and Other Names:Nimbex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 2mg/mL
  • 10mg/mL
more...

Neuromuscular Blockade

Initial intubating doses: 0.15-0.2 mg/kg IV 

Maintenance Dose

  • 0.03 mg/kg IV
  • Dose necessary 40-50 minutes following initial dose of 0.15 mg/kg
  • Dose necessary 50-60 minutes following initial dose of 0.2 mg/kg

IV Infusion (During Extended Surgery or In ICU)

3 mcg/kg/min post-bolus to prevent rapid spontaneous recovery of neuromuscular blockade, THEN 

1-2 mcg/kg/min for maintenance; dose range of 0.5-10 mcg/kg/min reported

Reduce infusion rate by 30%-40% when given during stable isoflurane or enflurane anesthesia

Dosage Forms & Strengths

injectable solution

  • 2mg/mL
  • 10mg/mL
more...

Neuromuscular Blockade

1-24 months: 0.15 mg/kg over 5-10 seconds during either halothane or opioid anesthesia 

2-12 years: 0.1-0.15 mg/kg over 5-15 seconds during either halothane or opioid anesthesia

IV Infusion (During Extended Surgery or In ICU)

<2 years

  • Safety & efficacy not established

>2 years

  • 3 mcg/kg/min post-bolus to prevent rapid spontaneous recovery of neuromuscular blockade, THEN
  • 1-2 mcg/kg/min for maintenance; dose range of 0.5-10 mcg/kg/min reported
  • Reduce infusion rate by 30%-40% when given during stable isoflurane or enflurane anesthesia
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Interactions

Interaction Checker

and cisatracurium

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            Adverse Effects

            <1%

            Bronchospasm

            Bradycardia

            Flushing

            Pruritus

            Myositis ossificans

            Hypotension

            Rash

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            Warnings

            Contraindications

            Hypersensitivity to cisatracurium (or benzyl alcohol if 10 mL vial is used)

            RSI (due to intermediate onset)

            Cautions

            Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken

            Do not administer before unconsciousness

            May cause a profound effect in those with myasthenia gravis or the myasthenic syndrome

            May require higher doses in burns

            Bradycardia may occur

            Cross sensitivity with other neuromuscular-blocking agents may occur; use caution in patients with previous anaphylactive reactions to neuromuscular blocking agents

            Hepatic impairment: onset time is faster (~1 min) and recovery is slower (~1 min)

            Maximum blockage time about 1 min slower in geriatric and renally impaired pts

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: excretion in milk unknown; use with caution

            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.

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            Pharmacology

            Mechanism of Action

            Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist; a cis-isomer of atracurium

            Pharmacokinetics

            Half-Life: 22-29 min

            Onset: 2-3 min (IV; mean for 0.15-0.2 mg/kg adult dose)

            Duration: 55-65 min

            Peak plasma time: 3-5 min

            Vd: 145 mL/kg

            Metabolism: Forms inactive metabolites

            Excretion: Urine 95%

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            Administration

            IV Incompatibilities

            Solution: LR

            Y-site:

            • Incompatible: cefoperazone, diazepam(?), ketorolac, propofol
            • Incompatible at 5 mg/mL cisatracurium (may be compatible at 2 mg/mL or less): acyclovir, aminophylline, amphotericin B, ampicillin, ampicillin-sulbactam, cefotetan, ceftizoxime, cetazidime (?), ganciclovir, heparin, piperacillin-tazobactam, ticarcillin-clavulanate
            • Incompatible at 2 & 5 mg/mL cisatracurium (may be compatible at 0.1 mg/mL): cefazolin, cefotaxime, cefoxitin, cefuroxime, furosemide, methylprednisolone, piperacillin, sodium bicarbonate, sodium nitroprusside, thiopental, trimethoprim-sulfamethoxazole

            May be incompatible with highly alkaline drug solutions

            IV Preparation

            Dilute in D5W, NS or D5/NS

            As low as 0.1 mg/mL can be stored at room temp or refrigerated for 24 hr

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            Formulary

            FormularyPatient Discounts

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            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.
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