cisatracurium (Rx)

Brand and Other Names:Nimbex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 2mg/mL (multidose vial)
  • Contains benzyl alcohol

injectable solution, preservative free

  • 2mg/mL (single-dose vial)
  • 10mg/mL (single-dose vial)

Neuromuscular Blockade

Indicated as an adjunct to general anesthesia to facilitate tracheal intubation

Also indicated for skeletal muscle relaxation during surgical procedures or mechanical ventilation in ICU settings

Initial dose

  • In conjunction with propofol or thiopental/ nitrous oxide/oxygen induction technique
  • 0.15-0.2 mg/kg IV bolus initially  
  • Doses up to 0.4 mg/kg IV bolus have been safely administered to healthy patients and patients with serious cardiovascular disease

Maintenance dose, intermittent

  • 0.03 mg/kg IV bolus; start 40-50 min (after initial dose of 0.15 mg/kg) or 50-60 min (after initial dose of 0.2 mg/kg)
  • Smaller or larger doses may be administered based on required duration of action
  • Consider less frequent or lower maintenance bolus doses for long surgical procedures using inhalational anesthetics administered with nitrous oxide/oxygen at the 1.25 MAC level for at least 30 min
  • No adjustment to initial maintenance bolus dose necessary when administered shortly after initiation of volatile agents or used in patients receiving propofol anesthesia

Maintenance dose, continuous infusion

  • Use during extended surgical procedures OR during extended need for mechanical ventilation and skeletal muscle relaxation in the ICU if spontaneous recovery occurs after initial bolus dose
  • May be necessary to readminister a bolus dose following recovery from neuromuscular blockade to re-establish neuromuscular blockade before starting infusion
  • Infuse at 3 mcg/kg/min initially; subsequently reduce rate to 1-2 mcg/kg/min to maintain neuromuscular blockade
  • Assess level of neuromuscular blockage using peripheral nerve stimulation and titrate appropriately
  • Discontinue if no response is elicited to peripheral nerve stimulation
  • Administration during isoflurane anesthesia or other inhalational anesthetics
    • Consider reducing infusion rate by up to 30-40% during stable isoflurane anesthesia for at least 30 min (administered with nitrous oxide/oxygen at the 1.25 MAC level)
    • Longer durations of administration of isoflurane or with administration of other inhalational anesthetics may require greater reductions in infusion rate

Dosage Modifications

Patients with neuromuscular disease

  • Includes myasthenia gravis, myasthenic syndrome, carcinomatosis
  • Maximum initial dose: 0.2 mg/kg IV bolus

Patients with burn injuries

  • Shown to develop resistance to nondepolarizing neuromuscular blocking agents
  • Consider increasing dosages for intubation and maintenance

Patients undergoing coronary artery bypass graft (CABG) surgery

  • Consider reducing infusion rate for continuous infusions in patients undergoing CABG with induced hypothermia to half the rate required during normothermia
  • Spontaneous recovery from neuromuscular block following discontinuation of infusion is expected proceed at a rate comparable to that following administration of a single bolus dose

Patients with hemiparesis or paraparesis

  • Patients with hemiparesis or paraparesis may demonstrate resistance to nondepolarizing muscle relaxants in affected limbs
  • To avoid inaccurate dosing, perform neuromuscular monitoring on a nonparetic limb

Renal impairment

  • End-stage renal disease
    • Consider extending interval between administration and intubation by at least 1 min to achieve adequate intubation
    • Use peripheral nerve stimulator to determine adequate muscle relaxation for intubation and timing/amount of subsequent doses

Hepatic impairment

  • End-stage liver disease undergoing liver transplantation
    • Pharmacokinetic study reported slightly larger volume of distribution and plasma concentration of cisatracurium
    • Time to maximum blockade for a 1 mg/kg-dose was ~1 min faster

Dosing Considerations

Before initiating, consider desired time of tracheal intubation, anticipated length of surgery, factor affecting onset of complete neuromuscular block (eg, age, renal function), factors that may influence intubation conditions such as presence of co-induction agents (eg, fentanyl, midazolam), and depth of anesthesia

Limitations of use

  • Not recommended for rapid sequence endotracheal intubation due to time required for its onset of action

Dosage Forms & Strengths

injectable solution

  • 2mg/mL (multidose vial)
  • Contains benzyl alcohol

injectable solution, preservative free

  • 2mg/mL (single-dose vial)
  • 10mg/mL (single-dose vial)

Tracheal Intubation

Indicated as an adjunct to general anesthesia to facilitate tracheal intubation in adults and in children aged 1 month to 12 years

1-23 months: 0.15 mg/kg IV bolus  

2-12 years: 0.1-0.15 mg/kg IV bolus

Skeletal Muscle Relaxation During Surgery

Indicated for skeletal muscle relaxation during extended surgical procedures via IV infusion in children aged ≥2 years

Maintenance continuous infusion aged >2 years

  • Use during extended surgical procedures if spontaneous recovery occurs after initial bolus dose
  • May be necessary to readminister a bolus dose following recovery from neuromuscular blockade to re-establish neuromuscular blockade before starting infusion
  • Infuse at 3 mcg/kg/min initially; subsequently reduce rate to 1-2 mcg/kg/min to maintain neuromuscular blockade  
  • Assess level of neuromuscular blockage using peripheral nerve stimulation and titrate appropriately
  • Discontinue if no response is elicited to peripheral nerve stimulation
Administration during isoflurane anesthesia or other inhalational anesthetics
  • Consider reducing infusion rate by up to 30-40% during stable isoflurane anesthesia for at least 30 min (administered with nitrous oxide/oxygen at the 1.25 MAC level)
  • Longer durations of administration of isoflurane or with administration of other inhalational anesthetics may require greater reductions in infusion rate

Dosage Modifications

Patients with neuromuscular disease

  • Includes myasthenia gravis, myasthenic syndrome, carcinomatosis
  • Maximum initial dose: 0.2 mg/kg IV bolus

Patients with burn injuries

  • Shown to develop resistance to nondepolarizing neuromuscular blocking agents
  • Consider increasing dosages for intubation and maintenance

Renal impairment

  • End-stage renal disease
    • Consider extending interval between administration and intubation by at least 1 min to achieve adequate intubation
    • Use peripheral nerve stimulator to determine adequate muscle relaxation for intubation and timing/amount of subsequent doses

Hepatic impairment

  • End-stage liver disease undergoing liver transplantation
    • Pharmacokinetic study reported slightly larger volume of distribution and plasma concentration of cisatracurium
    • Time to maximum blockade for a 1 mg/kg-dose was ~1 min faster

Dosing Considerations

Before initiating, consider desired time of tracheal intubation, anticipated length of surgery, factor affecting onset of complete neuromuscular block (eg, age, renal function), factors that may influence intubation conditions such as presence of co-induction agents (eg, fentanyl, midazolam), and depth of anesthesia

Limitations of use

  • Not recommended for rapid sequence endotracheal intubation due to time required for its onset of action
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Interactions

Interaction Checker

and cisatracurium

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              Serious - Use Alternative (29)

              • amikacin

                amikacin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • amphotericin B deoxycholate

                amphotericin B deoxycholate increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, cisatracurium. 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.

              • capreomycin

                capreomycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • clindamycin

                clindamycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • colistin

                cisatracurium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.

              • demeclocycline

                demeclocycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • doxycycline

                doxycycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • fentanyl

                fentanyl, cisatracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl intranasal

                fentanyl intranasal, cisatracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl transdermal

                fentanyl transdermal, cisatracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • fentanyl transmucosal

                fentanyl transmucosal, cisatracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

              • gentamicin

                gentamicin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • hydrocodone

                hydrocodone, cisatracurium. 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.

              • lincomycin

                lincomycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • minocycline

                minocycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • neomycin PO

                neomycin PO increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • omadacycline

                omadacycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • oxytetracycline

                oxytetracycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • paromomycin

                paromomycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • polymyxin B

                polymyxin B increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

              • pramlintide

                pramlintide, cisatracurium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

              • quinine

                quinine increases effects of cisatracurium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

              • sarecycline

                sarecycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • streptomycin

                streptomycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • sufentanil SL

                sufentanil SL, cisatracurium. 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.

              • tetracycline

                tetracycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • tobramycin

                tobramycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • valerian

                valerian and cisatracurium both increase sedation. Avoid or Use Alternate Drug.

              Monitor Closely (109)

              • abobotulinumtoxinA

                cisatracurium increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Neuromuscular blockers may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • aclidinium

                cisatracurium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amitriptyline

                cisatracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amoxapine

                cisatracurium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • anticholinergic/sedative combos

                anticholinergic/sedative combos and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • aripiprazole

                cisatracurium decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

                aripiprazole increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atracurium

                atracurium and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine

                atropine and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine IV/IM

                atropine IV/IM and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna alkaloids

                belladonna alkaloids and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna and opium

                cisatracurium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • benperidol

                cisatracurium decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                benperidol increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • betamethasone

                cisatracurium, betamethasone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • bethanechol

                bethanechol increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                cisatracurium increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

              • carbachol

                carbachol increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cevimeline

                cevimeline increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpromazine

                cisatracurium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

                chlorpromazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • clomipramine

                cisatracurium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clozapine

                cisatracurium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

                clozapine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • corticotropin

                cisatracurium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • cortisone

                cisatracurium, cortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • cyclizine

                cisatracurium and cyclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • cyclobenzaprine

                cisatracurium and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • darifenacin

                cisatracurium and darifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • deflazacort

                cisatracurium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • dexamethasone

                cisatracurium, dexamethasone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • dicyclomine

                cisatracurium and dicyclomine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • diphenhydramine

                cisatracurium and diphenhydramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • donepezil

                donepezil increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                cisatracurium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • doxapram

                doxapram decreases effects of cisatracurium by pharmacodynamic antagonism. Use Caution/Monitor.

              • doxepin

                cisatracurium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • droperidol

                cisatracurium decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                droperidol increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • echothiophate iodide

                echothiophate iodide increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fesoterodine

                cisatracurium and fesoterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • flavoxate

                cisatracurium and flavoxate both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • fludrocortisone

                cisatracurium, fludrocortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • fluphenazine

                cisatracurium decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                fluphenazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • fosphenytoin

                fosphenytoin decreases effects of cisatracurium by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Monitor closely for more rapid recovery from neuromuscular blockade than expected; infusion rate requirements may be higher.

              • galantamine

                galantamine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate inhaled

                cisatracurium and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • haloperidol

                cisatracurium decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                haloperidol increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • henbane

                cisatracurium and henbane both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • homatropine

                cisatracurium and homatropine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • huperzine A

                huperzine A increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hydrocortisone

                cisatracurium, hydrocortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • hyoscyamine

                cisatracurium and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • hyoscyamine spray

                cisatracurium and hyoscyamine spray both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • iloperidone

                cisatracurium decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                iloperidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • imipramine

                cisatracurium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ipratropium

                cisatracurium and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • lofepramine

                cisatracurium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • loxapine

                cisatracurium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

                loxapine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • loxapine inhaled

                loxapine inhaled increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                cisatracurium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

              • magnesium sulfate

                magnesium sulfate increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

              • magnesium supplement

                magnesium supplement, cisatracurium. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.

              • maprotiline

                cisatracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • meclizine

                cisatracurium and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • methscopolamine

                cisatracurium and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • methylprednisolone

                cisatracurium, methylprednisolone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • neostigmine

                neostigmine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                cisatracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • olanzapine

                cisatracurium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

                olanzapine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • oliceridine

                oliceridine, cisatracurium. 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.

              • onabotulinumtoxinA

                onabotulinumtoxinA and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • orphenadrine

                cisatracurium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin

                cisatracurium and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin topical

                cisatracurium and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin transdermal

                cisatracurium and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxycodone

                oxycodone increases effects of cisatracurium by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Oxycodone may enhance the neuromuscular blocking action of true skeletal muscle relaxants and produce an increased degree of respiratory depression.

              • paliperidone

                cisatracurium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                paliperidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pancuronium

                cisatracurium and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • perphenazine

                cisatracurium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                perphenazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • phenytoin

                phenytoin decreases effects of cisatracurium by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Monitor closely for more rapid recovery from neuromuscular blockade than expected; infusion rate requirements may be higher.

              • physostigmine

                physostigmine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine

                pilocarpine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine ophthalmic

                pilocarpine ophthalmic increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pimozide

                cisatracurium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

                pimozide increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pralidoxime

                cisatracurium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • prednisolone

                cisatracurium, prednisolone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • prednisone

                cisatracurium, prednisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • prochlorperazine

                cisatracurium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                prochlorperazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • promethazine

                cisatracurium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

                promethazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • propantheline

                cisatracurium and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • protriptyline

                cisatracurium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • pyridostigmine

                pyridostigmine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quetiapine

                cisatracurium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

                quetiapine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rapacuronium

                cisatracurium and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • risperidone

                cisatracurium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rocuronium

                cisatracurium and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • scopolamine

                cisatracurium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • sevoflurane

                sevoflurane increases levels of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases effects of cisatracurium by Other (see comment). Use Caution/Monitor. Comment: Magnesium may potentiate the effects of the neuromuscular blocking agents.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases effects of cisatracurium by Other (see comment). Use Caution/Monitor. Comment: Magnesium may potentiate the effects of the neuromuscular blocking agents.

              • solifenacin

                cisatracurium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • succinylcholine

                succinylcholine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                cisatracurium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

                thioridazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • thiothixene

                cisatracurium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

                thiothixene increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tiotropium

                cisatracurium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • tobramycin inhaled

                tobramycin inhaled increases effects of cisatracurium by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Aminoglycosides may aggravate muscle weakness because of a curare-like effect.

              • tolterodine

                cisatracurium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • triamcinolone acetonide injectable suspension

                cisatracurium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

              • trifluoperazine

                cisatracurium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                trifluoperazine increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • trimipramine

                cisatracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trospium chloride

                cisatracurium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • vecuronium

                cisatracurium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ziprasidone

                cisatracurium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

                ziprasidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • zotepine

                cisatracurium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (39)

              • acetazolamide

                acetazolamide decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • amlodipine

                amlodipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • carbamazepine

                carbamazepine decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • clevidipine

                clevidipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • clonazepam

                clonazepam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • desipramine

                cisatracurium and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

              • diazepam

                diazepam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • diltiazem

                diltiazem increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • dimenhydrinate

                dimenhydrinate increases toxicity of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

              • donepezil

                donepezil decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • eslicarbazepine acetate

                eslicarbazepine acetate decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • ethosuximide

                ethosuximide decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • felbamate

                felbamate decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • felodipine

                felodipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • gabapentin

                gabapentin decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • gabapentin enacarbil

                gabapentin enacarbil decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • galantamine

                galantamine decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • isradipine

                isradipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • lacosamide

                lacosamide decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • lamotrigine

                lamotrigine decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • levetiracetam

                levetiracetam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • lithium

                lithium increases effects of cisatracurium by unknown mechanism. Minor/Significance Unknown.

              • lorazepam

                lorazepam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • methsuximide

                methsuximide decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • nicardipine

                nicardipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • nifedipine

                nifedipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • nisoldipine

                nisoldipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • oxcarbazepine

                oxcarbazepine decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • phenobarbital

                phenobarbital decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • primidone

                primidone decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • quinidine

                quinidine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown.

              • rufinamide

                rufinamide decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • thiamine

                thiamine increases effects of cisatracurium by unspecified interaction mechanism. Minor/Significance Unknown.

              • tiagabine

                tiagabine decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • topiramate

                topiramate decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • trazodone

                cisatracurium and trazodone both decrease cholinergic effects/transmission. Minor/Significance Unknown.

              • valproic acid

                valproic acid decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

              • verapamil

                verapamil increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • zonisamide

                zonisamide decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

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              Adverse Effects

              <1%

              Bronchospasm

              Bradycardia

              Flushing

              Pruritus

              Myositis ossificans

              Hypotension

              Rash

              Postmarketing Reports

              Anaphylaxis

              Histamine release

              Prolonged neuromuscular block

              Muscle weakness, myopathy

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              Warnings

              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)

              Cautions

              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

              The 20-mL vials contain no preservatives and are intended only for IV infusion in a single patient in the ICU; not to be used as a multidose vial for different patients because there is a higher risk of infection

              Not studied in malignancy hyperthermia (MH)-susceptible patients; MH can develop in absence of established triggering agents; prepare to recognize and treat MH in any patient undergoing general anesthesia

              Residual paralysis

              • Residual paralysis has been associated with therapy
              • Lower maximum initial bolus in patients at higher risk of residual paralysis (eg, patients with neuromuscular diseases, carcinomatosis)
              • Extubation is recommended only after patient has recovered sufficiently from neuromuscular blockade
              • Consider use of a reversal agent especially in cases where residual paralysis is more likely to occur

              Risk of serious adverse reactions in infants due to benzyl alcohol

              • Serious and fatal adverse reactions including “gasping syndrome” can occur in neonates and infants treated with benzyl alcohol-containing drugs
              • Multidose 10-mL vials contains benzyl alcohol; not applicable in single-dose 5-mL or 20-mL vials
              • “Gasping syndrome” is characterized by CNS depression, metabolic acidosis, and gasping respirations
              • Use of 10-mL vials is contraindicated in infants <1 month or have low birth-weight

              Drug interaction overview

              • Succinylcholine
                • Use of succinylcholine before cisatracurium administration may decrease onset of maximum neuromuscular blockade but has no effect on duration of neuromuscular blockade
              • Inhalational anesthetics
                • Administration of inhalational anesthetics with nitrous oxide/oxygen for >30 min to achieve 1.25 minimum alveolar concentration may prolong duration of action of initial and maintenance doses; may potentiate the neuromuscular blockade
              • Potentiation of neuromuscular blockade
                • Certain drugs may enhance neuromuscular blocking action including inhalational anesthetics, antibiotics, magnesium salts, lithium, local anesthetics, procainamide and quinidine
                • Additionally, acid-base and/or serum electrolyte abnormalities may potentiate taction of neuromuscular blocking agents
                • Use peripheral nerve stimulation; monitor clinical signs of neuromuscular blockade and adjust dose, if necessary
              • Resistance to neuromuscular blockade with certain drugs
                • Shorter durations of neuromuscular block may occur; may require higher infusion rates in patients chronically administered phenytoin or carbamazepine
                • Use peripheral nerve stimulation and monitor the clinical signs of neuromuscular blockade
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              Pregnancy & Lactation

              Pregnancy

              There are no adequate and well-controlled studies in pregnant women; animal studies conducted in rats administered cisatracurium besylate during organogenesis found no evidence of fetal harm at 0.8 times (ventilated rats) the exposure from a human starting IV bolus dose of 0.2 mg/kg

              Labor or delivery

              • The action of neuromuscular blocking agents may be enhanced by magnesium salts administered for management of preeclampsia or eclampsia of pregnancy

              Lactation

              It is not known whether drug is present in human milk; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for therapy and any potential adverse effects on breastfed child from treatment or from underlying maternal condition

              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

              Absorption

              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

              Distribution

              Vd (steady-state): 145 mL/kg

              Metabolism

              Degradation was largely independent of liver metabolism

              Elimination

              Clearance: 4.57 mL/min/kg

              Half-life: 22 min

              Half-life of metabolites are longer in patients with renal or hepatic impairment; metabolite concentration may be higher after long-term administration

              Excretion: 95% (urine); 4% (feces)

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              Administration

              IV Incompatibilities

              Do not administer alkaline solutions have a pH >8.5 (eg, barbiturate solutions) simultaneously in same IV line

              Y-site administration

              • Ketorolac injection
              • Propofol injection

              IV Compatibilities

              • D5W
              • 0.9% NaCl
              • D5W 0.9% NaCl

              Y-site administration

              • D5W
              • 0.9% NaCl
              • D5W 0.9% NaCl
              • Sufentanil
              • Alfentanil
              • Fentanyl citrate
              • Midazolam
              • Droperidol

              IV Preparation

              Visually inspect for particulate matter and discoloration before administration; solution should appear slightly yellow or greenish-yellow solution; discard if solution appears cloudy or contains particulates

              Dilute in following solutions

              • Final concentration 0.1 mg/mL
                • D5W
                • 0.9% NaCl
                • D5W 0.9% NaCl
              Final concentration 0.1-0.2 mg/mL
              • D5W

              IV Administration

              Initial or maintenance bolus dose: Administer undiluted IV push over 5-10 sec

              Continuous infusion: Refer to prescribing information

              Storage

              Unopened vials

              • Refrigerate at 2-8ºC (36-46ºF) in carton to preserve potency; do NOT freeze
              • Protect from light
              • Upon removal from refrigeration to room temperature (25ºC/77ºF), use within 21 days, even if re-refrigerated

              Diluted solutions

              • 0.1 mg/mL concentration: Refrigerate or store at room temperature for up to 24 hr
              • 0.1-0.2 mg/mL concentration: Refrigerate for up to 24 hr
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              cisatracurium intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              cisatracurium intravenous
              -
              2 mg/mL vial
              Nimbex intravenous
              -
              2 mg/mL vial
              Nimbex intravenous
              -
              10 mg/mL conc. (ICU USE ONLY) vial
              Nimbex intravenous
              -
              2 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              cisatracurium 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) 2021 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.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              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.
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              • 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.
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              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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.