Cisatracurium Hameln Injection
Cisatracurium besylate
5 mg/2.5 ml
ZAS Corporation
| Pack size | 2.5 ml amp |
|---|---|
| Dispensing mode | |
| Source | |
| Agent | |
| Retail Price | 520.00 AED |
Available as:
Indications
Cisatracurium Hameln Injection is used for:
Facilitate mechanical ventilation in intensive care, Facilitate endotracheal intubation, Muscle relaxant in general anaesthesia
Adult Dose
Intravenous
According to BNF
Neuromuscular blockade (intermediate duration) during surgery and intubation
Adult:
Initially, 150 mcg/kg by intravenous injection. Then,
Maintenance: 30 mcg/kg by inj (each dose provides 20 min of additional block), may also be given by infusion at an initial rate of 3 mcg/kg/min
(180 micrograms/kg/hour) followed by a rate of 1-2 mcg/kg/min (60–120 micrograms/kg/hour).
Maintenance dose is administered after stabilisation.
Neuromuscular blockade (intermediate duration) during intensive care
Adult:
Initially 150 micrograms/kg, initial dose is optional, then (by intravenous infusion) 180 micrograms/kg/hour, adjusted according to response; (by intravenous infusion) usual dose 30–600 micrograms/kg/hour
According to FDAF
Neuromuscular Blockade
Indicated as an adjunct to general anesthesia to facilitate tracheal intubation
Also indicated for skeletal muscle relaxation during surgical procedures or mechanical ventilation in ICU settings
Initial dose
In conjunction with propofol or thiopental/ nitrous oxide/oxygen induction technique 0.15-0.2 mg/kg IV bolus initially
Doses up to 0.4 mg/kg IV bolus have been safely administered to healthy patients and patients with serious cardiovascular disease
Maintenance dose, intermittent
0.03 mg/kg IV bolus; start 40-50 min (after initial dose of 0.15 mg/kg) or 50-60 min (after initial dose of 0.2 mg/kg)
Maintenance dose, continuous infusion
Use during extended surgical procedures OR during extended need for mechanical ventilation and skeletal muscle relaxation in the ICU if spontaneous recovery occurs after initial bolus dose
May be necessary to readminister a bolus dose following recovery from neuromuscular blockade to re-establish neuromuscular blockade before starting infusion
Infuse at 3 mcg/kg/min initially; subsequently reduce rate to 1-2 mcg/kg/min to maintain neuromuscular blockade
Patients with neuromuscular disease
Includes myasthenia gravis, myasthenic syndrome, carcinomatosis
Maximum initial dose: 0.2 mg/kg IV bolus
Child Dose
Intravenous
Tracheal Intubation
Indicated as an adjunct to general anesthesia to facilitate tracheal intubation in adults and in children aged 1 month to 12 years
1-23 mth Initially, 150 mcg/kg by inj over 5-10 sec, during halothane or opiate anaesth;
2-12 yr Initially, 100-150 mcg/kg by inj over 5-10 sec, during halothane or opiate anaesth.
Maintenance: 20 mcg/kg by inj (each dose provides 9 min of additional block), may also be given by infusion at an initial rate of 3 mcg/kg/min followed by a rate of 1-2 mcg/kg/min.
Skeletal Muscle Relaxation During Surgery
Indicated for skeletal muscle relaxation during extended surgical procedures via IV infusion in children aged ?2 years
Maintenance continuous infusion aged >2 years
Infuse at 3 mcg/kg/min initially; subsequently reduce rate to 1-2 mcg/kg/min to maintain neuromuscular blockade
Renal Dose
Renal impairment
End-stage renal disease
Consider extending interval between administration and intubation by at least 1 min to achieve adequate intubation
Use peripheral nerve stimulator to determine adequate muscle relaxation for intubation and timing/amount of subsequent doses
Administration
IV Preparation
Visually inspect for particulate matter and discoloration before administration; solution should appear slightly yellow or greenish-yellow solution; discard if solution appears cloudy or contains particulates
Dilute in following solutions
Final concentration 0.1 mg/mL
D5W
0.9% NaCl
D5W 0.9% NaCl
Final concentration 0.1-0.2 mg/mL
D5W
IV Administration
Initial or maintenance bolus dose: Administer undiluted IV push over 5-10 sec
Continuous infusion: Refer to prescribing information
Contra Indications
Hypersensitivity to cisatracurium (or benzyl alcohol if 10 mL vial is used)
Use of 10 mL vial in pediatric patients <1 month of age and low birth-weight infants (contains benzyl alcohol)
Precautions
Residual Paralysis: Patients with neuromuscular diseases are at higher risk.
Use a lower initial bolus dose and consider using a reversal agent in these patients.
Benzyl Alcohol: Consider the combined daily load of benzyl alcohol from all sources when the 10 mL multiple dose vials are used in infants.
Risk of Seizure: Monitor level of neuromuscular blockade during long-term administration to limit exposure to toxic metabolites.
Hypersensitivity Reactions and Anaphylaxis: Severe hypersensitivity reactions including anaphylactic reactions have been reported. Consider cross-reactivity among neuromuscular blocking agents, both depolarizing and non-depolarizing.
Risk of Death due to Medication Errors: Accidental administration can cause death.
Inadequate Anesthesia: Use Cisatracurium in the presence of appropriate sedation or general anesthesia and monitor patients to ensure level of anesthesia is adequate.
Monitoring Parameters
Monitor heart rate, BP, resp rate; peripheral nerve stimulator twitch response (when appropriate).
Monitor level of neuromuscular blockade during long-term administration to limit exposure to toxic metabolites.
Pregnancy-Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women; animal studies conducted in rats administered cisatracurium besylate during organogenesis found no evidence of fetal harm at 0.8 times (ventilated rats) the exposure from a human starting IV bolus dose of 0.2 mg/kg
Labor or delivery
The action of neuromuscular blocking agents may be enhanced by magnesium salts administered for management of preeclampsia or eclampsia of pregnancy
Lactation
It is not known whether drug is present in human milk; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for therapy and any potential adverse effects on breastfed child from treatment or from underlying maternal condition
Interactions
Increased effect w/ anaesth agents (e.g. enflurane, isoflurane, halothane, ketamine), other non-depolarising neuromuscular blocking agents, certain antibiotics (e.g. aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin, clindamycin), anti-arrhythmic drugs (e.g. propranolol, Ca channel blockers, lidocaine, procainamide, quinidine), diuretics (e.g. furosemide, and possibly thiazides, mannitol and acetazolamide), Mg and lithium salts, ganglion blocking drugs (e.g. trimetaphan, hexamethonium).
Decreased effect w/ phenytoin, carbamazepine, anticholinesterases (e.g. donepezil).
Succinylcholine: May decrease time to onset of maximum neuromuscular blockade
Inhalational anesthetics, antibiotics, local anesthetics, magnesium salts, procainamide, lithium, quinidine: May potentiate or prolong neuromuscular blockade action of Cisatracurium. Use a peripheral nerve stimulator and monitor clinical signs of neuromuscular blockade.
Phenytoin and Carbamazepine: May shorten the duration of neuromuscular blockade. Use a peripheral nerve stimulator and monitor clinical signs of neuromuscular blockade.
Contraindicated (0)
Serious (29)
amikacin
amphotericin B deoxycholate
benzhydrocodone/acetaminophen
capreomycin
clindamycin
colistin
demeclocycline
doxycycline
fentanyl
fentanyl intranasal
fentanyl transdermal
fentanyl transmucosal
gentamicin
hydrocodone
lincomycin
minocycline
neomycin PO
omadacycline
oxytetracycline
paromomycin
polymyxin B
pramlintide
quinine
sarecycline
streptomycin
sufentanil SL
tetracycline
tobramycin
valerian
Adverse Effects
Side effects of Cisatracurium besylate :
<1%
Bronchospasm
Bradycardia
Flushing
Pruritus
Myositis ossificans
Hypotension
Rash
Mechanism of Action
Cisatracurium antagonises the action of acetylcholine by binding to cholinergic receptors on the motor end-plate, resulting in a competitive block of neuromuscular transmission.
Note
Cisatracurium Hameln 5 mg/2.5 ml Injection manufactured by ZAS Corporation. Its generic name is Cisatracurium besylate. Cisatracurium Hameln is availble in Bangladesh.
Farmaco BD drug index information on Cisatracurium Hameln Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.