services or products [10%:32 cm H 2 O) (Papazian 2010). Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric Neuromuscular blockade: IV (not to be used IM): Operating room administration: Infants 1-23 months: Intubating dose: 0.15 mg/kg over 5-10 seconds Children 2-12 years: Intubating dose: 0.1-0.15 mg/kg over 5-10 seconds ( Note: When given during stable opioid/nitrous oxide/oxygen anesthesia, 0.1 mg/kg produces maximum neuromuscular block in an average of 2.8 minutes and clinically effective block for 28 minutes.) Children 2 years: Continuous infusion: Refer to adult dosing. Intensive care unit administration: Refer to adult dosing. Dosing: Renal Impairment Because slower times to onset of complete neuromuscular block were observed in renal dysfunction patients, extending the interval between the administration of cisatracurium and intubation attempt may be required to achieve adequate intubation conditions. Dosing: Hepatic Impairment No dosage adjustment provided in manufacturer s labeling. The time to onset of action was ~1 minute faster in patients with end-stage liver disease, but was not associated with clinically significant changes in recovery time. Administration Administer IV only; give undiluted as bolus injection over 5-10 seconds. Continuous infusion requires the use of an infusion pump. The use of a peripheral nerve stimulator will permit the most advantageous use of cisatracurium, minimize the possibility of overdosage or underdosage and assist in the evaluation of recovery. Do not administer IM (excessive tissue irritation). Storage 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 of 25 C (77 F). Per the manufacturer, dilutions of 0.1 mg/mL in 0.9% sodium chloride (NS), dextrose 5% in water (D 5 W), or D 5 NS are stable for up to 24 hours at room temperature or under refrigeration; dilutions of 0.1-0.2 mg/mL in D 5 LR are stable for up to 24 hours in the refrigerator. Additional stability data: Dilutions of 0.1, 2, and 5 mg/mL in D 5 W or NS are stable in the refrigerator for up to 30 days; at room temperature (23 C), dilutions of 0.1 and 2 mg/mL began exhibiting substantial drug loss between 7-14 days; dilutions of 5 mg/mL in D 5 W or NS are stable for up to 30 days at room temperature (23 C) (Xu, 1998). Usual concentration: 0.1-0.4 mg/mL. Drug Interactions AbobotulinumtoxinA: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Acetylcholinesterase Inhibitors: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Amifampridine: Neuromuscular-Blocking Agents may diminish the therapeutic effect of Amifampridine. Amifampridine may diminish the therapeutic effect of Neuromuscular-Blocking Agents. Monitor therapy Aminoglycosides: May enhance the respiratory depressant effect of Neuromuscular-Blocking Agents. Monitor therapy Bacitracin (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Calcium Channel Blockers: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Capreomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy CarBAMazepine: May decrease the serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Cardiac Glycosides: Neuromuscular-Blocking Agents may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy Clindamycin (Topical): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Colistimethate: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Consider therapy modification Corticosteroids (Systemic): Neuromuscular-Blocking Agents (Nondepolarizing) may enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Consider therapy modification CycloSPORINE (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Fosphenytoin-Phenytoin: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may decrease the serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Inhalational Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Ketorolac (Nasal): May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Monitor therapy Ketorolac (Systemic): May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Monitor therapy Lincosamide Antibiotics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Lithium: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Local Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Exceptions: Benzocaine; Benzydamine; Cocaine; Dibucaine; Dyclonine; Ethyl Chloride; Hexylresorcinol; Lidocaine (Ophthalmic); Lidocaine (Topical); Pramoxine; Proparacaine; Tetracaine (Ophthalmic); Tetracaine (Topical). Monitor therapy Loop Diuretics: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Magnesium Salts: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Minocycline: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy OnabotulinumtoxinA: Neuromuscular-Blocking Agents may enhance the neuromuscular-blocking effect of OnabotulinumtoxinA. Monitor therapy Pholcodine: May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents. Specifically, anaphylaxis has been reported. Monitor therapy Polymyxin B: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Consider therapy modification Procainamide: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy QuiNIDine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy QuiNINE: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Avoid combination RimabotulinumtoxinB: Neuromuscular-Blocking Agents may enhance the neuromuscular-blocking effect of RimabotulinumtoxinB. Monitor therapy Spironolactone: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Tetracyclines: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Trimebutine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy Vancomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Adverse Reactions Effects are minimal and transient.] Drug Status Rx Availability Prescription only B Pregnancy Category No proven risk in humans N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Cisatracurium Rating No Reviews - Be the first! 5.0 /10 No Reviews - Be the first! 5.0 Rate it! Manufacturers Sandoz Inc. Fresenius Kabi USA, LLC Drug Class Neuromuscular blocking agents Related Drugs neuromuscular blocking agents succinylcholine , rocuronium , vecuronium , atracurium Anesthesia lidocaine , fentanyl , hyoscyamine , propofol , Levsin , ketamine , glycopyrrolate , Emla , Robinul , butorphanol , etomidate , succinylcholine , More... Light Anesthesia lorazepam , diazepam , Ativan , Valium , midazolam , Versed , Diastat , Nimbex , Diastat AcuDial , Zetran , More... recognise
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