Dosing & Uses
Dosage Forms & Strengths
capsule
- 25mg
- 50mg
- 100mg
powder for injection
- 20mg/vial (Dantrium, Revonto)
- 250mg/vial (Ryanodex)
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
Monitor overnight in hospital for 24-48 hr
For more information, see Malignant Hyperthermia Association of the United States (MHAUS) recommendations; https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/
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
Organophosphate Exposure (Orphan)
Ryanodex: Orphan designation for treatment of organophosphate exposure
Sponsor
- Eagle Pharmaceuticals, Inc; 50 Tice Blvd, Suite 315; Woodcliff Lake, New Jersey 07677
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)
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
Monitor overnight in hospital for 24-48 hr
For more information, see Malignant Hyperthermia Association of the United States (MHAUS) recommendations; https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (8)
- amlodipine
dantrolene, amlodipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.
- diltiazem
dantrolene, diltiazem. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.
- felodipine
dantrolene, felodipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.
- levamlodipine
dantrolene, levamlodipine. Either increases toxicity of the other by unspecified interaction mechanism. Contraindicated. Cardiovascular collapse in association with marked hyperkalemia has been reported in patients receiving dantrolene in combination with calcium channel blockers. .
- nicardipine
dantrolene, nicardipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.
- nisoldipine
dantrolene, nisoldipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.
- vecuronium
dantrolene, vecuronium. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. May potentiate vecuronium-induced neuromuscular block.
- verapamil
dantrolene, verapamil. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.
Serious - Use Alternative (28)
- apalutamide
apalutamide will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
benzhydrocodone/acetaminophen and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine subdermal implant
buprenorphine subdermal implant and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
buprenorphine transdermal and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- calcium/magnesium/potassium/sodium oxybates
dantrolene, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- carbamazepine
carbamazepine will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- enzalutamide
enzalutamide will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fentanyl
fentanyl and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl intranasal
fentanyl intranasal and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl iontophoretic transdermal system
fentanyl iontophoretic transdermal system and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transdermal
fentanyl transdermal and dantrolene both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fexinidazole
fexinidazole will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.
- fosphenytoin
fosphenytoin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- hydrocodone
hydrocodone, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- idelalisib
idelalisib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- ivosidenib
ivosidenib will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lonafarnib
lonafarnib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.
- metoclopramide intranasal
dantrolene, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
- olopatadine intranasal
dantrolene and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- pexidartinib
dantrolene and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.
- phenobarbital
phenobarbital will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- phenytoin
phenytoin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- primidone
primidone will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- sodium oxybate
dantrolene, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sufentanil SL
sufentanil SL, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- tucatinib
tucatinib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- voxelotor
voxelotor will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (185)
- abobotulinumtoxinA
dantrolene increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- acrivastine
acrivastine and dantrolene both increase sedation. Use Caution/Monitor.
- alfentanil
dantrolene and alfentanil both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and dantrolene both increase sedation. Use Caution/Monitor.
- amisulpride
amisulpride and dantrolene both increase sedation. Use Caution/Monitor.
- amitriptyline
dantrolene and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and dantrolene both increase sedation. Use Caution/Monitor.
amobarbital will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - amoxapine
dantrolene and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
dantrolene and apomorphine both increase sedation. Use Caution/Monitor.
- aripiprazole
dantrolene and aripiprazole both increase sedation. Use Caution/Monitor.
- asenapine
asenapine and dantrolene both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and dantrolene both increase sedation. Use Caution/Monitor.
- avapritinib
avapritinib and dantrolene both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and dantrolene both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and dantrolene both increase sedation. Use Caution/Monitor.
- belladonna and opium
dantrolene and belladonna and opium both increase sedation. Use Caution/Monitor.
- belzutifan
belzutifan will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- benperidol
dantrolene and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
dantrolene increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bosentan
bosentan will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- brexanolone
brexanolone, dantrolene. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and dantrolene both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and dantrolene both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and dantrolene both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and dantrolene both increase sedation. Use Caution/Monitor.
- buprenorphine
dantrolene and buprenorphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
dantrolene and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection increases effects of dantrolene by Other (see comment). Modify Therapy/Monitor Closely. Comment: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and increase risk for respiratory depression. Monitor for signs of respiratory depression that may be greater than otherwise expected and decrease muscle relaxant dosage as necessary.
- butabarbital
butabarbital and dantrolene both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and dantrolene both increase sedation. Use Caution/Monitor.
- butorphanol
dantrolene and butorphanol both increase sedation. Use Caution/Monitor.
- carbamazepine
dantrolene will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor plasma levels when used concomitantly
- carbinoxamine
carbinoxamine and dantrolene both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and dantrolene both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
cenobamate, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor. - chloral hydrate
chloral hydrate and dantrolene both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and dantrolene both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and dantrolene both increase sedation. Use Caution/Monitor.
- chlorpromazine
dantrolene and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
chlorzoxazone and dantrolene both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and dantrolene both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and dantrolene both increase sedation. Use Caution/Monitor.
- clobazam
dantrolene, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
dantrolene and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and dantrolene both increase sedation. Use Caution/Monitor.
- clorazepate
clorazepate and dantrolene both increase sedation. Use Caution/Monitor.
- clozapine
dantrolene and clozapine both increase sedation. Use Caution/Monitor.
- codeine
dantrolene and codeine both increase sedation. Use Caution/Monitor.
- crofelemer
crofelemer increases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- cyclizine
cyclizine and dantrolene both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and dantrolene both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and dantrolene both increase sedation. Use Caution/Monitor.
- dabrafenib
dabrafenib will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- daridorexant
dantrolene and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desipramine
dantrolene and desipramine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and dantrolene both increase sedation. Use Caution/Monitor.
- dexfenfluramine
dantrolene increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and dantrolene both increase sedation. Use Caution/Monitor.
- dextromoramide
dantrolene and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
dantrolene and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and dantrolene both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, dantrolene. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- difelikefalin
difelikefalin and dantrolene both increase sedation. Use Caution/Monitor.
- difenoxin hcl
dantrolene and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and dantrolene both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and dantrolene both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
dantrolene and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
dantrolene and dipipanone both increase sedation. Use Caution/Monitor.
- dopexamine
dantrolene increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
dantrolene and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
dantrolene and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
doxylamine and dantrolene both increase sedation. Use Caution/Monitor.
- droperidol
dantrolene and droperidol both increase sedation. Use Caution/Monitor.
- efavirenz
efavirenz will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- elagolix
elagolix will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- encorafenib
encorafenib, dantrolene. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- esketamine intranasal
esketamine intranasal, dantrolene. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and dantrolene both increase sedation. Use Caution/Monitor.
- ethanol
dantrolene and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and dantrolene both increase sedation. Use Caution/Monitor.
- etravirine
etravirine will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fedratinib
fedratinib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- fenfluramine
dantrolene increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fluphenazine
dantrolene and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
flurazepam and dantrolene both increase sedation. Use Caution/Monitor.
- ganaxolone
dantrolene and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
dantrolene and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
dantrolene and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and dantrolene both increase sedation. Use Caution/Monitor.
- iloperidone
dantrolene and iloperidone both increase sedation. Use Caution/Monitor.
iloperidone increases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. - imipramine
dantrolene and imipramine both increase sedation. Use Caution/Monitor.
- incobotulinumtoxinA
dantrolene, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- istradefylline
istradefylline will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- ketamine
ketamine and dantrolene both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
dantrolene and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, dantrolene. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- lenacapavir
lenacapavir will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- levorphanol
dantrolene and levorphanol both increase sedation. Use Caution/Monitor.
- lofepramine
dantrolene and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
dantrolene and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
loprazolam and dantrolene both increase sedation. Use Caution/Monitor.
- lorazepam
lorazepam and dantrolene both increase sedation. Use Caution/Monitor.
- lorlatinib
lorlatinib will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lormetazepam
lormetazepam and dantrolene both increase sedation. Use Caution/Monitor.
- loxapine
dantrolene and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
dantrolene and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, dantrolene. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
dantrolene and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
dantrolene and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
dantrolene and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
dantrolene and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
dantrolene and meprobamate both increase sedation. Use Caution/Monitor.
- metaxalone
dantrolene and metaxalone both increase sedation. Use Caution/Monitor.
- methadone
dantrolene and methadone both increase sedation. Use Caution/Monitor.
- methocarbamol
dantrolene and methocarbamol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
dantrolene increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
midazolam and dantrolene both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, dantrolene. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- mirtazapine
dantrolene and mirtazapine both increase sedation. Use Caution/Monitor.
- mitotane
mitotane decreases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- morphine
dantrolene and morphine both increase sedation. Use Caution/Monitor.
- motherwort
dantrolene and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
dantrolene and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
dantrolene and nabilone both increase sedation. Use Caution/Monitor.
- nafcillin
nafcillin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nalbuphine
dantrolene and nalbuphine both increase sedation. Use Caution/Monitor.
- nortriptyline
dantrolene and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
dantrolene and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
dantrolene increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics. - opium tincture
dantrolene and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
dantrolene and orphenadrine both increase sedation. Use Caution/Monitor.
- oxazepam
oxazepam and dantrolene both increase sedation. Use Caution/Monitor.
- oxycodone
dantrolene and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
dantrolene and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
dantrolene and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
dantrolene and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
dantrolene and papaverine both increase sedation. Use Caution/Monitor.
- pentazocine
dantrolene and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and dantrolene both increase sedation. Use Caution/Monitor.
- perphenazine
dantrolene and perphenazine both increase sedation. Use Caution/Monitor.
- phenobarbital
phenobarbital and dantrolene both increase sedation. Use Caution/Monitor.
- phenylephrine PO
dantrolene increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
dantrolene and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
dantrolene and pimozide both increase sedation. Use Caution/Monitor.
- prabotulinumtoxinA
dantrolene increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- primidone
primidone and dantrolene both increase sedation. Use Caution/Monitor.
- prochlorperazine
dantrolene and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and dantrolene both increase sedation. Use Caution/Monitor.
- propofol
propofol and dantrolene both increase sedation. Use Caution/Monitor.
- propylhexedrine
dantrolene increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
dantrolene and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
quazepam and dantrolene both increase sedation. Use Caution/Monitor.
- quetiapine
dantrolene and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
dantrolene and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, dantrolene. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- rifabutin
rifabutin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
dantrolene and risperidone both increase sedation. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- scullcap
dantrolene and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and dantrolene both increase sedation. Use Caution/Monitor.
- shepherd's purse
dantrolene and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, dantrolene. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
stiripentol, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - sufentanil
dantrolene and sufentanil both increase sedation. Use Caution/Monitor.
- tapentadol
dantrolene and tapentadol both increase sedation. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- temazepam
temazepam and dantrolene both increase sedation. Use Caution/Monitor.
- thioridazine
dantrolene and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
dantrolene and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
dantrolene and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
dantrolene and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
dantrolene and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
triazolam and dantrolene both increase sedation. Use Caution/Monitor.
- triclofos
triclofos and dantrolene both increase sedation. Use Caution/Monitor.
- trifluoperazine
dantrolene and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
dantrolene and trimipramine both increase sedation. Use Caution/Monitor.
- valoctocogene roxaparvovec
dantrolene and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.
- xylometazoline
dantrolene increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
dantrolene and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
dantrolene and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
dantrolene and zotepine both increase sedation. Use Caution/Monitor.
Minor (8)
- acetazolamide
acetazolamide will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eucalyptus
dantrolene and eucalyptus both increase sedation. Minor/Significance Unknown.
- larotrectinib
larotrectinib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- levoketoconazole
levoketoconazole will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ribociclib
ribociclib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sage
dantrolene and sage both increase sedation. Minor/Significance Unknown.
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
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
Pregnancy & Lactation
Pregnancy
Available data on use in pregnant women are insufficient to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; the drug readily crosses placenta; however, no serious adverse events reported in neonate following maternal administration of drug prior to delivery; there are risks to pregnant woman and fetus associated with untreated malignant hyperthermia
Malignant hyperthermia is a medical emergency which can be fatal for the pregnant woman and fetus if left untreated; life-sustaining therapy should not be withheld due to pregnancy
Labor or Delivery
- In uncontrolled study, 100 mg per day of prophylactic oral dantrolene sodium was administered to term pregnant patients awaiting labor and delivery; the drug readily crossed placenta, with maternal and fetal whole blood levels approximately equal at delivery; neonatal levels then fell approximately 50% per day for 2 days before declining sharply; no neonatal respiratory and neuromuscular side effects were observed in this study
Animal data
- In animal reproduction studies, dantrolene sodium administered to rats and rabbits produced embryolethality (rabbits) and decreased pup survival (rats) at doses seven times the human oral dose
Lactation
Dantrolene is reported to be present in human milk following intravenous administration over 3 days; there are no data on effects on breastfed infant or effects on milk production; because of potential for serious adverse reactions in breastfed infant, including respiratory depression and muscle weakness, advise patients that breastfeeding is not recommended during treatment and for 3 days after last dose
A lactating woman should interrupt breastfeeding and pump and discard breast milk during treatment and for 3 days after last dose administered
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.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%)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Dantrium intravenous - | 20 mg vial |  | |
| dantrolene intravenous - | 20 mg vial |  | |
| Dantrium oral - | 50 mg capsule |  | |
| Dantrium oral - | 25 mg capsule |  | |
| dantrolene oral - | 100 mg capsule |  | |
| dantrolene oral - | 50 mg capsule |  | |
| dantrolene oral - | 25 mg capsule |  | |
| dantrolene oral - | 50 mg capsule |  | |
| dantrolene oral - | 25 mg capsule |  | |
| dantrolene oral - | 100 mg capsule |  | |
| dantrolene oral - | 50 mg capsule | | |
| dantrolene oral - | 25 mg capsule | | |
| dantrolene oral - | 100 mg capsule |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
dantrolene intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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