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Drug overview for CISATRACURIUM BESYLATE (cisatracurium besylate):
Generic name: CISATRACURIUM BESYLATE
Drug class: Neuromuscular Blockers
Therapeutic class: Locomotor System
Cisatracurium besylate, a benzylisoquinolone nondepolarizing neuromuscular blocking agent, is an isomer of atracurium.
No enhanced Uses information available for this drug.
Generic name: CISATRACURIUM BESYLATE
Drug class: Neuromuscular Blockers
Therapeutic class: Locomotor System
Cisatracurium besylate, a benzylisoquinolone nondepolarizing neuromuscular blocking agent, is an isomer of atracurium.
No enhanced Uses information available for this drug.
DRUG IMAGES
CISATRACURIUM 200 MG/20 ML VL
The following indications for CISATRACURIUM BESYLATE (cisatracurium besylate) have been approved by the FDA:
Indications:
General anesthesia adjunct
Muscle relaxation
Skeletal muscle relaxation for endotracheal intubation
Professional Synonyms:
Adjunct general anesthesia
Muscle flaccidity
Skeletal muscle relaxation for endotracheal tube insertion
Skeletal muscle relaxation for intratracheal intubation
Skeletal muscle relaxation for intubation of trachea
Indications:
General anesthesia adjunct
Muscle relaxation
Skeletal muscle relaxation for endotracheal intubation
Professional Synonyms:
Adjunct general anesthesia
Muscle flaccidity
Skeletal muscle relaxation for endotracheal tube insertion
Skeletal muscle relaxation for intratracheal intubation
Skeletal muscle relaxation for intubation of trachea
The following dosing information is available for CISATRACURIUM BESYLATE (cisatracurium besylate):
Dosage of cisatracurium besylate is expressed in terms of cisatracurium.
Dosage of cisatracurium must be carefully adjusted according to individual requirements and response. The use of a peripheral nerve stimulator is recommended to accurately monitor the degree of neuromuscular blockade and recovery, determine the need for additional doses, and minimize the possibility of overdosage.
The recommended initial intubating dose of cisatracurium in infants 1-23 months of age when used concomitantly with halothane or opiate anesthesia is 0.15 mg/kg. This dose generally produces maximum neuromuscular blockade in about 2 minutes and clinically effective blockade for about 43 minutes.
The recommended initial intubating dose of cisatracurium in children 2-12 years of age when used concomitantly with halothane or opiate anesthesia is 0.1-0.15 mg/kg.
A dose of 0.1 mg/kg administered under these conditions can be expected to produce maximum neuromuscular blockade in about 2.8 minutes and clinically effective blockade for about 28 minutes, and a dose of 0.15
mg/kg can be expected to produce maximum neuromuscular blockade in about 3 minutes and clinically effective blockade for about 36 minutes.
The manufacturer makes no specific dosage recommendations for adolescents 13 years of age or older.
After the initial intubating dose is administered, children 2 years of age or older may receive a continuous IV infusion of cisatracurium to maintain neuromuscular blockade during prolonged surgical procedures. The infusion should be initiated only after early spontaneous recovery from the initial dose is evident. The rate of infusion should be individualized based on patient response to peripheral nerve stimulation.
An initial rate of 3 mcg/kg per minute may be necessary to rapidly counteract spontaneous neuromuscular recovery; thereafter, a rate of 1-2 mcg/kg per minute generally is sufficient to maintain neuromuscular blockade in the range of 89-99% in most pediatric patients receiving balanced anesthesia.
A reduction in the cisatracurium infusion rate by up to 30-40% may be necessary if steady-state anesthesia has been induced with enflurane or isoflurane; greater reductions may be required with prolonged durations of enflurane or isoflurane administration.
The recommended initial (intubating) dose of cisatracurium in adults is 0.15 or 0.2 mg/kg depending on the desired time to intubation and duration of the procedure.
When used concomitantly with balanced anesthesia, good to excellent intubating conditions generally occur within 2 minutes following a dose of 0.15 mg/kg or 1.5 minutes following a dose of 0.2
mg/kg. A dose of 0.15 mg/kg generally produces maximum neuromuscular blockade in approximately 3.5
minutes and clinically sufficient neuromuscular blockade for about 55 minutes, and a dose of 0.2 mg/kg generally produces maximum neuromuscular blockade in approximately 2.9 minutes and clinically sufficient neuromuscular blockade for about 65 minutes.
For maintenance of neuromuscular blockade during prolonged surgical procedures, additional cisatracurium doses of 0.03 mg/kg may be administered by intermittent IV injection in adults. The first maintenance dose generally is required within 40-50 or 50-60 minutes following an initial dose of 0.15
or 0.2 mg/kg, respectively. Each 0.03-mg/kg
dose can provide approximately 20 minutes of additional neuromuscular blockade. Smaller or larger doses may be needed to provide shorter or longer durations of action.
Less frequent or lower doses of cisatracurium may be necessary when administered concomitantly with enflurane or isoflurane anesthesia during prolonged surgical procedures. No dosage adjustment appears to be necessary when the drug is administered shortly (e.g., within 15-30 minutes) after initiation of the inhalation anesthetic.
Alternatively, after the initial intubating dose is administered, patients may receive a continuous IV infusion of cisatracurium to maintain neuromuscular blockade during prolonged surgical procedures; the infusion should be initiated only after early spontaneous recovery from the initial dose is evident. Infusion rates should be individualized and adjusted based on patient response to peripheral nerve stimulation. An initial rate of 3 mcg/kg per minute may be necessary to rapidly counteract spontaneous recovery from neuromuscular blockade.
Thereafter, a maintenance infusion rate of 1-2 mcg/kg per minute generally is sufficient to maintain neuromuscular blockade in the range of 89-99% in most patients receiving balanced anesthesia.
A reduction in the cisatracurium infusion rate by up to 30-40% may be necessary if steady-state anesthesia has been induced with enflurane or isoflurane; greater reductions may be required with prolonged durations of enflurane or isoflurane administration.
Cisatracurium may be administered by continuous IV infusion for maintenance of neuromuscular blockade during mechanical ventilation in the intensive care unit (ICU). The degree of neuromuscular blockade should be monitored with a peripheral nerve stimulator; additional doses should not be given before there is a definite response to nerve stimulation.
In clinical studies, an average cisatracurium infusion rate of approximately 3 mcg/kg per minute was required for maintenance of neuromuscular blockade in mechanically ventilated adults in the ICU; however, dosage requirements may vary widely among patients and also may increase or decrease with time. In these studies, patients received up to 6 days of cisatracurium infusion; longer durations of use in the ICU have not been evaluated. Recovery of neuromuscular function (train-of-four (TOF) ratio of at least 0.7)
generally occurred within approximately 50-55 minutes after the infusion was discontinued. Following neuromuscular recovery, administration of an IV (''bolus'') dose of cisatracurium may be necessary to reestablish neuromuscular blockade prior to reinstitution of the infusion.
Dosage of cisatracurium must be carefully adjusted according to individual requirements and response. The use of a peripheral nerve stimulator is recommended to accurately monitor the degree of neuromuscular blockade and recovery, determine the need for additional doses, and minimize the possibility of overdosage.
The recommended initial intubating dose of cisatracurium in infants 1-23 months of age when used concomitantly with halothane or opiate anesthesia is 0.15 mg/kg. This dose generally produces maximum neuromuscular blockade in about 2 minutes and clinically effective blockade for about 43 minutes.
The recommended initial intubating dose of cisatracurium in children 2-12 years of age when used concomitantly with halothane or opiate anesthesia is 0.1-0.15 mg/kg.
A dose of 0.1 mg/kg administered under these conditions can be expected to produce maximum neuromuscular blockade in about 2.8 minutes and clinically effective blockade for about 28 minutes, and a dose of 0.15
mg/kg can be expected to produce maximum neuromuscular blockade in about 3 minutes and clinically effective blockade for about 36 minutes.
The manufacturer makes no specific dosage recommendations for adolescents 13 years of age or older.
After the initial intubating dose is administered, children 2 years of age or older may receive a continuous IV infusion of cisatracurium to maintain neuromuscular blockade during prolonged surgical procedures. The infusion should be initiated only after early spontaneous recovery from the initial dose is evident. The rate of infusion should be individualized based on patient response to peripheral nerve stimulation.
An initial rate of 3 mcg/kg per minute may be necessary to rapidly counteract spontaneous neuromuscular recovery; thereafter, a rate of 1-2 mcg/kg per minute generally is sufficient to maintain neuromuscular blockade in the range of 89-99% in most pediatric patients receiving balanced anesthesia.
A reduction in the cisatracurium infusion rate by up to 30-40% may be necessary if steady-state anesthesia has been induced with enflurane or isoflurane; greater reductions may be required with prolonged durations of enflurane or isoflurane administration.
The recommended initial (intubating) dose of cisatracurium in adults is 0.15 or 0.2 mg/kg depending on the desired time to intubation and duration of the procedure.
When used concomitantly with balanced anesthesia, good to excellent intubating conditions generally occur within 2 minutes following a dose of 0.15 mg/kg or 1.5 minutes following a dose of 0.2
mg/kg. A dose of 0.15 mg/kg generally produces maximum neuromuscular blockade in approximately 3.5
minutes and clinically sufficient neuromuscular blockade for about 55 minutes, and a dose of 0.2 mg/kg generally produces maximum neuromuscular blockade in approximately 2.9 minutes and clinically sufficient neuromuscular blockade for about 65 minutes.
For maintenance of neuromuscular blockade during prolonged surgical procedures, additional cisatracurium doses of 0.03 mg/kg may be administered by intermittent IV injection in adults. The first maintenance dose generally is required within 40-50 or 50-60 minutes following an initial dose of 0.15
or 0.2 mg/kg, respectively. Each 0.03-mg/kg
dose can provide approximately 20 minutes of additional neuromuscular blockade. Smaller or larger doses may be needed to provide shorter or longer durations of action.
Less frequent or lower doses of cisatracurium may be necessary when administered concomitantly with enflurane or isoflurane anesthesia during prolonged surgical procedures. No dosage adjustment appears to be necessary when the drug is administered shortly (e.g., within 15-30 minutes) after initiation of the inhalation anesthetic.
Alternatively, after the initial intubating dose is administered, patients may receive a continuous IV infusion of cisatracurium to maintain neuromuscular blockade during prolonged surgical procedures; the infusion should be initiated only after early spontaneous recovery from the initial dose is evident. Infusion rates should be individualized and adjusted based on patient response to peripheral nerve stimulation. An initial rate of 3 mcg/kg per minute may be necessary to rapidly counteract spontaneous recovery from neuromuscular blockade.
Thereafter, a maintenance infusion rate of 1-2 mcg/kg per minute generally is sufficient to maintain neuromuscular blockade in the range of 89-99% in most patients receiving balanced anesthesia.
A reduction in the cisatracurium infusion rate by up to 30-40% may be necessary if steady-state anesthesia has been induced with enflurane or isoflurane; greater reductions may be required with prolonged durations of enflurane or isoflurane administration.
Cisatracurium may be administered by continuous IV infusion for maintenance of neuromuscular blockade during mechanical ventilation in the intensive care unit (ICU). The degree of neuromuscular blockade should be monitored with a peripheral nerve stimulator; additional doses should not be given before there is a definite response to nerve stimulation.
In clinical studies, an average cisatracurium infusion rate of approximately 3 mcg/kg per minute was required for maintenance of neuromuscular blockade in mechanically ventilated adults in the ICU; however, dosage requirements may vary widely among patients and also may increase or decrease with time. In these studies, patients received up to 6 days of cisatracurium infusion; longer durations of use in the ICU have not been evaluated. Recovery of neuromuscular function (train-of-four (TOF) ratio of at least 0.7)
generally occurred within approximately 50-55 minutes after the infusion was discontinued. Following neuromuscular recovery, administration of an IV (''bolus'') dose of cisatracurium may be necessary to reestablish neuromuscular blockade prior to reinstitution of the infusion.
Cisatracurium is administered IV only. Commercially available 20-mL single-dose vials of cisatracurium besylate containing 10 mg/mL are intended for intensive care unit (ICU) use only.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| CISATRACURIUM 200 MG/20 ML VL | Maintenance | Adults infuse 3 mcg/kg/minute by continuous infusion route |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| CISATRACURIUM 200 MG/20 ML VL | Maintenance | Adults infuse 3 mcg/kg/minute by continuous infusion route |
The following drug interaction information is available for CISATRACURIUM BESYLATE (cisatracurium besylate):
There are 0 contraindications.
There are 4 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Misc Antibiotics/Neuromuscular Blocking Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Aminoglycosides, bacitracin, clindamycin, lincomycin, and polymyxins may enhance the pharmacologic effects of neuromuscular blocking agents. CLINICAL EFFECTS: May see an increase in the pharmacologic effects of neuromuscular blocking agents, including prolonged respiratory depression and apnea. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If it is necessary to administer these drugs concurrently, do so with extreme caution. Monitor neuromuscular function and adjust the dose of the neuromuscular blocking agent accordingly. DISCUSSION: Concomitant administration of aminoglycosides, bacitracin, clindamycin, lincomycin, and polymixins with neuromuscular blocking agents has been shown to produce synergism of the effects on skeletal muscles. Concurrent administration of these drugs has been associated with prolonged respiratory depression, respiratory paralysis, and fatal apnea. The interaction usually occurs when the antibiotic is given prior to or concurrently with the neuromuscular blocking drug, but it may also occur when given after administration. Any antibiotic dosage or route of administration may produce respiratory depression. |
AMIKACIN SULFATE, BETHKIS, COLISTIN SULFATE, GENTAMICIN SULFATE, GENTAMICIN SULFATE IN NS, HUMATIN, KANAMYCIN SULFATE, KITABIS PAK, NEOMYCIN SULFATE, PAROMOMYCIN SULFATE, STREPTOMYCIN SULFATE, TIGECYCLINE, TOBI, TOBI PODHALER, TOBRAMYCIN, TOBRAMYCIN SULFATE, TYGACIL |
| General Anesthetics (Inhl)/Neuromuscular Blocking Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: General anesthetics enhance the pharmacologic effects of nondepolarizing muscle relaxants. CLINICAL EFFECTS: May see an increase in the neuromuscular blocking effects of the nondepolarizing muscle relaxant including respiratory depression, bradycardia, hypotension, flushing, or muscle weakness. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: It may be necessary to decrease the dose of the nondepolarizing muscle relaxant. Monitor neuromuscular function and adjust the dose of the nondepolarizing muscle relaxant accordingly. DISCUSSION: Concomitant administration of general anesthetics and nondepolarizing muscle relaxants has been shown to produce synergistic neuromuscular blocking effects of nondepolarizing muscle relaxants. |
DESFLURANE, FORANE, ISOFLURANE, SEVOFLURANE, SUPRANE, TERRELL, ULTANE |
| Neuromuscular Blocking Agents/Quinine Derivatives SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Synergistic or additive pharmacologic activity. CLINICAL EFFECTS: May see an increase in the neuromuscular blocking effects, including profound sedation, respiratory depression, coma, and/or death. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concurrent administration of neuromuscular blocking agents and quinine derivatives during the first several hours of postoperative period. If administered, respiratory support may be needed. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: Administration of quinidine during the immediate postoperative period has been associated with respiratory paralysis and apnea. |
NUEDEXTA, QUALAQUIN, QUINIDINE GLUCONATE, QUINIDINE SULFATE, QUININE HCL, QUININE SULFATE |
| Neuromuscular Blocking Agents/Verapamil SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Unknown. CLINICAL EFFECTS: The neuromuscular blocking effect of nondepolarizing muscle relaxants may be extended, producing profound sedation, respiratory depression, coma, and/or death. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If possible, avoid administration of nondepolarizing neuromuscular blocking agents to patients receiving verapamil. When both drugs must be given, carefully monitor respiratory function to avoid prolonged neuromuscular blockade. If needed, blockade may be reversed by giving edrophonium. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: Patients receiving verapamil have experienced prolonged skeletal muscle paralysis after administration of usual therapeutic doses of a nondepolarizing neuromuscular blocking agent. While muscle paralysis was unresponsive to treatment with neostigmine, reversal of blockade has been achieved by administration of edrophonium. |
TRANDOLAPRIL-VERAPAMIL ER, VERAPAMIL ER, VERAPAMIL ER PM, VERAPAMIL HCL, VERAPAMIL SR |
There are 5 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Neuromuscular Blocking Agents/Polypeptide Antibiotics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Synergistic pharmacologic activity. Polymyxin B affects neuromuscular transmission by blocking acetylcholine receptors. Its action is thus post-synaptic and the neuromuscular block has no antagonists. Polymyxin B causes neostigmine resistance to d-tubocurarine blockade and calcium resistance to the blockade evoked by aminoglycoside antibiotics (1,2,3,4). A pre-synaptic mechanism may also be involved with decreased release of acetylcholine. CLINICAL EFFECTS: May see an increase in the neuromuscular blocking effects, including profound sedation, respiratory depression, coma, and/or death. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If it is necessary to administer these drugs concurrently, do so with extreme caution. Monitor neuromuscular function and adjust the dose of the neuromuscular blocking agent accordingly. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: Concomitant administration of polypeptide antibiotics and neuromuscular blocking agents has been shown to produce synergism of the effects on skeletal muscles. Concurrent administration of these drugs has been associated with prolonged respiratory depression, respiratory paralysis, and apnea. This interaction has been documented with colistimethate, polymyxin B, bacitracin, and vancomycin. |
BACITRACIN, BACITRACIN MICRONIZED, BACITRACIN ZINC, COLISTIMETHATE, COLISTIMETHATE SODIUM, COLY-MYCIN M PARENTERAL, POLYMYXIN B SULFATE, VANCOMYCIN, VANCOMYCIN HCL, VANCOMYCIN HCL-0.9% NACL, VANCOMYCIN HCL-D5W |
| Neuromuscular Blocking Agents/Lincosamides SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Lincosamides appear to augment the neuromuscular blocking effects of nondepolarizing muscle relaxants. CLINICAL EFFECTS: The effects of nondepolarizing neuromuscular relaxants may be prolonged leading to profound sedation, respiratory depression, coma, and/or death. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor respiratory function of the patient and provide the necessary support. In patients who have received nondepolarizing muscle relaxants, avoid use of lincosamides in the recovery room. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: Lincomycin has been reported to augment the neuromuscular blocking effect of pancuronium in seven anesthetized patients. The effect was readily antagonized by neostigmine administration. In a case report, clindamycin produced prolonged neuromuscular blockade in a patient who had received pancuronium. Neostigmine was ineffective in antagonizing the blockade. |
CLEOCIN HCL, CLEOCIN PEDIATRIC, CLEOCIN PHOSPHATE, CLINDAMYCIN (PEDIATRIC), CLINDAMYCIN HCL, CLINDAMYCIN PHOSPHATE, CLINDAMYCIN PHOSPHATE-D5W, CLINDAMYCIN-0.9% NACL, LINCOCIN, LINCOMYCIN HCL |
| Nondepolarizing Muscle Relaxants/Magnesium Salts, Injectable SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Magnesium may reduce postjunctional membrane neuromuscular blocking action of nondepolarizing muscle relaxants. Parenterally administered magnesium may potentiate the effects of the nondepolarizing muscle relaxants. CLINICAL EFFECTS: Increased neuromuscular blockade with profound sedation, respiratory depression, coma, and/or death. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor respiratory function when parenteral magnesium and nondepolarizing muscle relaxants are administered concurrently. Adjust the dose of the neuromuscular blocking agent accordingly. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: The effects of nondepolarizing muscle relaxants have been reported to be increased in laboratory animals and in humans by concomitant administration of magnesium sulfate. Respiratory depression has been reported. |
CLINIMIX E, DEXTROSE 5%-ELECTROLYTE #48, KABIVEN, MAGNESIUM CHLORIDE, MAGNESIUM CITRATE, MAGNESIUM OXIDE, MAGNESIUM SULFATE, MAGNESIUM SULFATE-0.9% NACL, MAGNESIUM SULFATE-D5W, NUTRILYTE, PERIKABIVEN, TPN ELECTROLYTES |
| Nondepolarizing Muscle Relaxants/Piperacillin SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Piperacillin may prolong the neuromuscular blockade of the nondepolarizing muscle relaxants.(1,2) CLINICAL EFFECTS: Concurrent use of nondepolarizing muscle relaxants and piperacillin may result in prolonged neuromuscular blockade including profound sedation, respiratory depression, coma, and/or death.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients should be monitored for increased or unexpected prolongation of neuromuscular blockade when using piperacillin with nondepolarizing muscle relaxants. Assure monitoring protocols are in place for patients receiving neuromuscular blocking agents. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: Concurrent use of nondepolarizing muscle relaxants and piperacillin may result in increased or prolonged neuromuscular blockage.(1,2) If these agents are used together, patients should be monitored closely for increased neuromuscular blockage. |
PIPERACILLIN-TAZOBACTAM, ZOSYN |
| BYDUREON BCISE, EXENATIDE, LIRAGLUTIDE, MOUNJARO, OZEMPIC, RYBELSUS, SAXENDA, SEMAGLUTIDE, SOLIQUA 100-33, TRULICITY, VICTOZA 2-PAK, VICTOZA 3-PAK, WEGOVY, XULTOPHY 100-3.6, ZEPBOUND |
The following contraindication information is available for CISATRACURIUM BESYLATE (cisatracurium besylate):
Drug contraindication overview.
Cisatracurium besylate is contraindicated in patients with known hypersensitivity to the drug or any of its components. Multiple-dose vials of cisatracurium containing benzyl alcohol are contraindicated in premature infants.
Cisatracurium besylate is contraindicated in patients with known hypersensitivity to the drug or any of its components. Multiple-dose vials of cisatracurium containing benzyl alcohol are contraindicated in premature infants.
There are 0 contraindications.
There are 1 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Malignant hyperthermia |
There are 2 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Myasthenia gravis |
| Pulmonary disease |
The following adverse reaction information is available for CISATRACURIUM BESYLATE (cisatracurium besylate):
Adverse reaction overview.
Adverse effects were uncommon in clinical trials in patients who received cisatracurium in conjunction with anesthetic agents or other drugs (e.g., opiates, propofol) during surgery; no adverse effects were reported with an incidence exceeding 1% in these studies. Similarly, adverse effects were uncommon in ICU patients receiving cisatracurium, but several cases of prolonged recovery were reported.
Adverse effects were uncommon in clinical trials in patients who received cisatracurium in conjunction with anesthetic agents or other drugs (e.g., opiates, propofol) during surgery; no adverse effects were reported with an incidence exceeding 1% in these studies. Similarly, adverse effects were uncommon in ICU patients receiving cisatracurium, but several cases of prolonged recovery were reported.
There are 6 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Bradycardia Bronchospastic pulmonary disease Hypotension Skin rash |
| Rare/Very Rare |
|---|
|
Anaphylaxis Seizure disorder |
There are 3 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Flushing |
| Rare/Very Rare |
|---|
|
Muscle weakness Myopathy |
The following precautions are available for CISATRACURIUM BESYLATE (cisatracurium besylate):
Safety and efficacy of cisatracurium have not been established in neonates (younger than 1 month of age). Each mL of cisatracurium besylate injection in multiple-dose vials contains 9 mg of benzyl alcohol. Although a causal relationship has not been established, administration of injections preserved with benzyl alcohol has been associated with toxicity in neonates.
Toxicity appears to have resulted from administration of large amounts (i.e., 100-400 mg/kg daily) of benzyl alcohol in these neonates. Although use of drugs preserved with benzyl alcohol should be avoided in neonates whenever possible, the American Academy of Pediatrics (AAP) states that the presence of small amounts of the preservative in a commercially available injection should not proscribe its use when indicated in neonates. Pediatric patients may exhibit faster clearance of cisatracurium than adults.
Onset of the drug is faster and duration is longer in pediatric patients compared with adults, and in infants compared with older children. In clinical studies, tracheal intubation was facilitated more reliably in children 1-4 years of age when cisatracurium was used in conjunction with halothane than when used in conjunction with opiates and nitrous oxide.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Toxicity appears to have resulted from administration of large amounts (i.e., 100-400 mg/kg daily) of benzyl alcohol in these neonates. Although use of drugs preserved with benzyl alcohol should be avoided in neonates whenever possible, the American Academy of Pediatrics (AAP) states that the presence of small amounts of the preservative in a commercially available injection should not proscribe its use when indicated in neonates. Pediatric patients may exhibit faster clearance of cisatracurium than adults.
Onset of the drug is faster and duration is longer in pediatric patients compared with adults, and in infants compared with older children. In clinical studies, tracheal intubation was facilitated more reliably in children 1-4 years of age when cisatracurium was used in conjunction with halothane than when used in conjunction with opiates and nitrous oxide.
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Category B. It is not known whether use of cisatracurium during labor, delivery, or cesarean section has any effects on the fetus.
It is not known whether cisatracurium is distributed into milk. Because many drugs are distributed into human milk, caution is advised if the drug is used in nursing women.
No overall differences in safety and efficacy have been observed in geriatric patients relative to younger adults, but increased sensitivity of some older patients cannot be ruled out. Minor alterations in cisatracurium pharmacokinetics (e.g., prolonged half-life, slower onset of action) have been observed in geriatric patients compared with younger individuals; however, these changes were not associated with substantial differences in recovery profile. Cisatracurium half-life may be slightly prolonged in geriatric patients.
The following prioritized warning is available for CISATRACURIUM BESYLATE (cisatracurium besylate):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for CISATRACURIUM BESYLATE (cisatracurium besylate)'s list of indications:
No ICD codes found for this drug.
No ICD codes found for this drug.
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