cisatracurium (Nimbex)
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Introduction
Tradename: Nimbex. (cisatracurium besylate)
Indications
- neuromuscular blockade in patients with renal insufficiency &/or hepatic insufficiency
- eases endotracheal intubation
- adjunctive agent to general anesthesia
- relaxation of skeletal muscle during mechanical ventilation
Contraindications
Caution:
- may produce profound effects in patients with neuromuscular disorders (i.e. myasthenia gravis)
- patients with severe burns may develop resistance
- maintenance of adequate airway & ventilatory support is necessary
- multidose vial contains benzyl alcohol
Dosage
- 0.1-0.2 mg/kg IV bolus, then
- 3 ug/kg/min, titrate to train of 4
- infuse in D5W or normal saline
- NOT compatible with lactated Ringer's (LR)
- no dosage adjustiment with renal insufficiency or hepatic insufficiency
Injection: 2 mg/mL (5 & 10 mL); 10 mg/mL (20 mL).
Pharmacokinetics
- Duration: 30-60 minutes.
elimination via plasma
Adverse effects
- uncommon (< 1%) (generally minimal & transient)
- respiratory depression, cardiovascular collapse
- neostigmine 1-3 mg IV push (adults), 0.5 mg (children) with or immediately after atropine 1.0-1.5 mg IV (adults)
Drug interactions
- agents that prolong neuromuscular blockade
- inhalation anesthetics
- halothane (marginal)
- reduce dosage by 30-40% in patients receiving enflurane or isoflurane
- local anesthetics
- lithium carbonate
- Mg+2 salts
- antiarrhythmic agents: quinidine, procainamide
- antibiotics:
- inhalation anesthetics
- resistance to neuromuscular blockade
- chronic phenytoin or carbamazepine
Mechanism of action
- neuromuscular blocking agent
- does not relieve pain