Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 10mg
- 20mg
General Anesthesia
Adjunct to general anesthesia-induced muscle relaxation for endotracheal intubation, mechanical ventilation
Dose should be calculated based on ideal body weight
Injection
- Load: 0.08-0.1 mg/kg IVP over 60 sec OR
- 0.04-0.06 mg/kg IVP if following succinylcholine, PLUS
- Maintenance: 0.01-0.015 mg/kg IVP 20-45min post initial PRN
Continuous Infusion
- Load: 0.001 mg/kg/min IV starting 20 min post bolus recovery
- Maintenance: 0.0008-0.0012 mg/kg/min
Dosage Forms & Strengths
powder for injection
- 10mg
- 20mg
General Anesthesia
Adjunct to general anesthesia-induce muscle relaxation for endotracheal intubation, mechanical ventilation
1-10 years old
Neonates; <28 days old (off-label)
- Load: 0.1 mg/kg IV x1 dose
- Maintenance: 0.03-0.15 mg/kg IV q1-2hours PRN
7 weeks-1 year old (off-label)
- Load: 0.08-0.1 mg/kg IV x1 dose
- Maintenance: 0.05-0.1 mg/kg IV q1hour PRN
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
Frequency Not Defined
Skeletal muscle weakness or paralysis
Respiratory insufficiency or apnea
Hypersensitivity reactions associated with histamine release (e.g., bronchospasm, flushing, erythema, acute urticaria, hypotension, tachycardia)
Itching
Myositis ossificans (prolonged use)
Acute quadriplegic myopathy syndrome (prolonged use)
Less cardiovascular effects than pancuronium or atracurium
Warnings
Black Box Warnings
The drug should be administered only by adequately trained individuals familiar with its actions, characteristics, and hazards
Contraindications
Hypersensitivity
Lack of ventilatory support
Neuromuscular disease
Cautions
Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent
Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken; neuromuscular cross-sensitivity with other nuromuscular blocking agents possible
Some patients may experience prolonged recovery (paralysis) of neuromuscular function
Adequate ventilatory support mandatory, may experience resistance with >25% TBSA burns, may experience increased sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)
CAUTION: Hepatobiliary obstruction, renal dysfunction will significantly prolong duration of action
Pregnancy & Lactation
Pregnancy Category: C
Lactation: Not known if excreted in breast milk; effect on nursing infant not known; used during pregnancy only when clearly needed
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
Pharmacokinetics
Half-life: 3.3-9 min (distribution phase); 31-80 min (terminal phase); increased in hepatobiliary disease
Clearance: 2.9-6.4 mL/min/kg (normal renal function); 2.5-4.5 mL/min/kg (renal dysfunction); 0.97-2.7 mL/min/kg (hepatic dysfunction)
Vd: 50-120 mL/kg (central compartment, Vc); 179-400 mL/kg (steady-state, Vss)
Metabolism: Not been fully characterized; aqueous solution in vitro has shown spontaneous deacetylation at the 3a- &/or 17ß-positions to form hydroxy derivatives
Onset: 3-5 min
Duration: 20-35 min
Protein Bound: 60-90%
Excretion: 30% excreted unchanged in urine, 45% excreted unchanged in bile/feces
Less histamine release than pancuroniun or atracurium (and less effect on HR & MAP)
Little effect on intraocular/intracranial pressure
Administration
IV Incompatibilities
Y-site: ampho B chol SO4, diazepam, etomidate, furosemide, thiopental
IV Compatibilities
Solution: NS, D5W, D5/NS, LR
Additive: ciprofloxacin
Y-site: aminophylline, amiodarone, cefazolin, cefuroxime, cimetidine, clarithromycin, diltiazem, dobutamine, dopamine, epinephrine, esmolol, fenoldopam, fentanyl, fluconazole, gatifloxacin, gentamicin, heparin, Hextend, hydrocortisone, hydromorphone, isoproterenol, labetalol, linezolid, lorazepam, midazolam, milrinone, morphine, nicardipine, nitroglycerin, norepinephrine, propofol, ranitidine, Na nitroprusside, trimethoprim/sulfamethoxazole, vancomycin
IV Preparation
Rapid direct injection: dilute vial to max of 2 mg/mL
Infusion: dilute vial to max of 1 mg/mL
Solution:
- Rapid direct injection: dilute vial to max of 2 mg/mL
- Infusion: dilute vial to max of 1 mg/mL
IV Administration
Give either as a rapid direct injection or as an infusion
Storage
Store at room temp
Do not mix with alkaline drugs
Images
Patient Handout
Formulary
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.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
