Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
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.
Adverse Effects
<1%
Bronchospasm
Bradycardia
Flushing
Pruritus
Myositis ossificans
Hypotension
Rash
Postmarketing Reports
Anaphylaxis
Histamine release
Prolonged neuromuscular block
Muscle weakness, myopathy
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
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.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)
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
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.
Patient Handout
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.
Formulary
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