Cisatracurium – Nimbex ®
|The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.|
Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate]
| (Using 200mg/20 ml vial)
[200 mg/ 180 ml] (total volume=200ml)
[100 mg/ 90 ml] (total volume= 100 ml)
(Using 2 mg/ml vials)
(May also be given undiluted)
Stability / Miscellaneous
Other: Stability: Refrigerate intact vials at 2°C to 8°C/36°F to 46°F; use vials within 21 days upon removal from the refrigerator to room temperature (25°C to 77°F). Dilutions of 0.1-0.2 mg/mL in 0.9% sodium chloride or dextrose 5% in water are stable for up to 24 hours at room temperature.
Drug of choice in the following cases (1) hemodynamically significant increases in HR (e.g. >20%) while paralyzed with pancuronium or MAP>110. (2) Concurrent corticosteroid administration (>72hrs) (3) Significant renal dysfunction (CRCL < 30 ml/min) (4) History of asthma or bronchospasm.
DOSAGE AND ADMINISTRATION
The dosage information provided below is intended as a guide only. Doses of NIMBEX should be individualized (see package insert for CLINICAL PHARMACOLOGY – Individualization of Dosages). The use of a peripheral nerve stimulator will permit the most advantageous use of NIMBEX, minimize the possibility of overdosage or underdosage, and assist in the evaluation of recovery.
Because slower times to onset of complete neuromuscular block were observed in elderly patients and patients with renal dysfunction, extending the interval between administration of NIMBEX and the intubation attempt for these patients may be required to achieve adequate intubation conditions.
A dose of 0.03 mg/kg NIMBEX is recommended for maintenance of neuromuscular block during prolonged surgical procedures. Maintenance doses of 0.03 mg/kg each sustain neuromuscular block for approximately 20 minutes. Maintenance dosing is generally required 40 to 50 minutes following an initial dose of 0.15 mg/kg NIMBEX and 50 to 60 minutes following an initial dose of 0.20 mg/kg NIMBEX, but the need for maintenance doses should be determined by clinical criteria. For shorter or longer durations of action, smaller or larger maintenance doses may be administered.
Isoflurane or enflurane administered with nitrous oxide/oxygen to achieve 1.25 MAC (Minimum Alveolar Concentration) may prolong the clinically effective duration of action of initial and maintenance doses. The magnitude of these effects may depend on the duration of administration of the volatile agents. Fifteen to 30 minutes of exposure to 1.25 MAC isoflurane or enflurane had minimal effects on the duration of action of initial doses of NIMBEX and therefore, no adjustment to the initial dose should be necessary when NIMBEX is administered shortly after initiation of volatile agents. In long surgical procedures during enflurane or isoflurane anesthesia, less frequent maintenance dosing or lower maintenance doses of NIMBEX may be necessary. No adjustments to the initial dose of NIMBEX are required when used in patients receiving propofol anesthesia.
Use by Continuous Infusion
Infusion of NIMBEX should be initiated only after early evidence of spontaneous recovery from the initial bolus dose. An initial infusion rate of 3 mcg/kg/min may be required to rapidly counteract the spontaneous recovery of neuromuscular function. Thereafter, a rate of 1 to 2 mcg/kg/min should be adequate to maintain continuous neuromuscular block in the range of 89% to 99% in most pediatric and adult patients under opioid/nitrous oxide/oxygen anesthesia.
Reduction of the infusion rate by up to 30% to 40% should be considered when NIMBEX is administered during stable isoflurane or enflurane anesthesia (administered with nitrous oxide/oxygen at the 1.25 MAC level). Greater reductions in the infusion rate of NIMBEX may be required with longer durations of administration of isoflurane or enflurane.
The rate of infusion of atracurium required to maintain adequate surgical relaxation in patients undergoing coronary artery bypass surgery with induced hypothermia (25° to 28°C) is approximately half the rate required during normothermia. Based on the structural similarity between NIMBEX and atracurium, a similar effect on the infusion rate of NIMBEX may be expected.
Spontaneous recovery from neuromuscular block following discontinuation of infusion of NIMBEX may be expected to proceed at a rate comparable to that following administration of a single bolus dose.
Infusion in the Intensive Care Unit (ICU)
Infusion Rate Tables
NIMBEX Injection Compatibility and Admixtures
NIMBEX Injection is acidic (pH = 3.25 to 3.65) and may not be compatible with alkaline solution having a pH greater than 8.5 (e.g., barbiturate solutions).
Studies have shown that NIMBEX Injection is compatible with:
NIMBEX Injection is not compatible with DIPRIVAN® (propofol) Injection or TORADOL® (ketorolac) Injection for Y-site administration. Studies of other parenteral products have not been conducted.
NIMBEX Injection should not be diluted in Lactated Ringer’s Injection, USP due to chemical instability.
NOTE: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Solutions which are not clear, or contain visible particulates, should not be used. NIMBEX Injection is a colorless to slightly yellow or greenish-yellow solution.
NOTE:10 mL Multiple-dose Vials contain 0.9% w/v benzyl alcohol as a preservative (see WARNINGS concerning newborn infants).
NIMBEX Injection, 10 mg cisatracurium per mL is supplied in the following:
Intended only for use in the ICU.
U.S. Patent No. 5,453,510
Mfd By: Hospira, Inc.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer