Dosing and uses of Nimbex (cisatracurium)
Adult dosage forms and strengths
injectable solution
- 2mg/mL
- 10mg/mL
Neuromuscular Blockade
Initial intubating doses: 0.15-0.2 mg/kg IV
Maintenance Dose
- 0.03 mg/kg IV
- 40-50 minutes following initial dose of 0.15 mg/kg
- 50-60 minutes following initial dose of 0.2 mg/kg
IV Infusion (During Extended Surgery or In ICU)
3 mcg/kg/min post-bolus to prevent rapid spontaneous recovery of neuromuscular blockade, THEn
1-2 mcg/kg/min for maintenance
Reduce infusion rate by 30%-40% when given during stable isoflurane or enflurane anesthesia
Other Indications & Uses
Adjunct to general anesthesia-induce muscle relaxation for endotracheal intubation, mechanical ventilation
Pediatric dosage forms and strengths
injectable solution
- 2mg/mL
- 10mg/mL
Neuromuscular Blockade
1-24 months old: 0.15 mg/kg over 5-10 seconds during either halothane or opioid anesthesia
2-12 years old: 0.1-0.15 mg/kg over 5-15 seconds during either halothane or opioid anesthesia
IV Infusion (During Extended Surgery or In ICU)
<2 years old: Safety & efficacy not established
>2 years old: As in adults
Nimbex (cisatracurium) adverse (side) effects
<1%
Bronchospasm
Bradycardia
Flushing
Hypotension
Rash
Warnings
Contraindications
Hypersensitivity to cisatracurium (or benzyl alcohol if 10 mL vial is used)
RSI (due to intermediate onset)
Cautions
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
Do not administer before unconsciousness
May cause a profound effect in those with myasthenia gravis or the myasthenic synd
May require higher doses in burns
Hepatic impairment: onset time is faster (~1 min) and recovery is slower (~1 min)
Maximum blockage time about 1 min slower in geriatric and renally impaired pts
Pregnancy and lactation
Pregnancy category: B
Lactation: excretion in milk unknown; use with caution
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 of Nimbex (cisatracurium)
Half-Life, Elim: 22-29 min
Onset: 2.4-2.6 min (mean for 0.15-0.2 mg/kg adult dose)
Duration: 55-65 min
Vd: 145 mL/kg
Metabolism: forms inactive metabolites
Excretion: urine 95%
Mechanism of action
Non-depolarizing skeletal musc. relaxant; cholinergic receptor antagonist; a cis-isomer of atracurium
Administration
IV Incompatibilities
Solution: Lr
Y-site:
- Incompatible: cefoperazone, diazepam(?), ketorolac, propofol
- Incompatible at 5 mg/mL cisatracurium (may be compatible at 2 mg/mL or less): acyclovir, aminophylline, amphotericin B, ampicillin, ampicillin-sulbactam, cefotetan, ceftizoxime, cetazidime (?), ganciclovir, heparin, piperacillin-tazobactam, ticarcillin-clavulanate
- Incompatible at 2 & 5 mg/mL cisatracurium (may be compatible at 0.1 mg/mL): cefazolin, cefotaxime, cefoxitin, cefuroxime, furosemide, methylprednisolone, piperacillin, sodium bicarbonate, sodium nitroprusside, thiopental, trimethoprim-sulfamethoxazole
May be incompatible with highly alkaline drug solutions
IV Preparation
Dilute in D5W, NS or D5/Ns
As low as 0.1 mg/mL can be stored at room temp or refrigerated for 24 hr
