life like [1:1% in clinical trials. 1 Intensive care patients: Prolonged recovery from neuromuscular blockade. 1 Interactions for Cisatracurium Besylate Specific Drugs Drug Interaction Comments Anesthetics, general (enflurane, isoflurane) Increased potency and prolonged duration of neuromuscular blockade 1 21 32 Reduced cisatracurium dose and/or infusion rate may be necessary 1 32 Anesthetics, local Possible increased neuromuscular blockade 1 3 Anticonvulsants (carbamazepine, phenytoin) Possible resistance to cisatracurium in patients receiving long-term phenytoin or carbamazepine therapy 1 3 30 Higher cisatracurium infusion rates may be necessary 1 30 Anti-infectives (aminoglycosides, bacitracin, clindamycin, lincomycin, polymyxins, tetracyclines) Possible increased neuromuscular blockade 1 3 Lithium Possible increased neuromuscular blockade 1 3 Magnesium salts Increased neuromuscular blockade 1 3 40 Use with caution; reduced cisatracurium dosage may be necessary 40 Neuromuscular blocking agents, nondepolarizing Potency and duration of nondepolarizing neuromuscular blocking agents may be altered by concurrent or prior administration of other nondepolarizing agents 31 Vecuronium, pancuronium, or atracurium has been administered safely following various degrees of recovery from cisatracurium-induced blockade 1 Procainamide Possible increased neuromuscular blockade 1 3 Propofol No apparent effect on duration of neuromuscular blockade 1 No dosage adjustment required 1 Quinidine Possible increased neuromuscular blockade 1 3 Succinylcholine Prior administration of succinylcholine may decrease time to maximum neuromuscular blockade with cisatracurium by about 2 minutes 1 Prior administration of succinylcholine does not appear to alter duration of blockade induced by intermittent injections of cisatracurium; prior administration resulted in no change or only slight increase in cisatracurium infusion requirements 1 Cisatracurium has been used safely following various degrees of recovery from succinylcholine-induced neuromuscular blockade 1 Cisatracurium Besylate Pharmacokinetics Absorption Bioavailability Poorly absorbed from GI tract. 23 Onset Intermediate onset of action. 1 5 Generally, time to maximum neuromuscular blockade decreases as dose increases; time to maximum blockade is up to 2 minutes longer with cisatracurium than with equipotent doses of atracurium. 1 5 Good to excellent conditions for tracheal intubation occur within 1.5 2 or 1.5 minutes following IV dose of 0.15 or 0.2 mg/kg, respectively. 1 5 Onset is faster in pediatric patients than in adults; also faster in infants than in older children. 1 Onset may be delayed in geriatric patients compared with younger adults. 1 16 In adults, doses of 0.15 or 0.2 mg/kg administered under balanced anesthesia produce maximum neuromuscular blockade in about 3.5 (range: 1.6 6.8) or 2.9 (range: 1.9 5.2) minutes, respectively. 1 Maximum neuromuscular blockade after 0.1-mg/kg dose occurs about 1 minute later in geriatric patients than in younger adults. 1 In children, doses of 0.1 or 0.15 mg/kg administered under balanced anesthesia produce maximum neuromuscular blockade in about 2.8 (range: 1.8 6.7) or 3 (range: 1.5 8) minutes, respectively. 1 In infants, doses of 0.15 mg/kg administered under balanced anesthesia produce maximum neuromuscular blockade in about 2 minutes (range: 1.3 4.3). 1 Duration Intermediate duration of action. 1 5 6 20 Duration of maximum neuromuscular blockade increases as the dose increases; when the cisatracurium dose is doubled, the clinically effective duration of blockade increases by approximately 25 minutes. 1 Clinically effective duration of action and rate of spontaneous recovery with equipotent doses of cisatracurium and atracurium are similar. 1 Duration is longer in adults than in pediatric patients; also longer in infants than in older children. 1 No substantial difference in recovery profiles between geriatric and younger adults. 1 11 16 Recovery following reversal is faster in children than in adults. 1 In adults, clinically effective duration of neuromuscular blockade (i.e., time to 25% recovery) after dose of 0.15 or 0.2 mg/kg is 55 (range: 44 74) or 65 (range: 43 103) minutes, respectively. 1 In children 2 12 years of age, clinically effective duration of neuromuscular blockade after dose of 0.1 or 0.15 mg/kg is approximately 28 (range: 21 38) or 36 (range: 29 46) minutes, respectively. 1 In infants, clinically effective duration of neuromuscular blockade after dose of 0.15 mg/kg is approximately 43 minutes (range: 34 58 minutes). 1 Duration of neuromuscular blockade induced by 0.03-mg/kg maintenance dose is approximately 20 minutes. 1 In studies in patients receiving long-term (i.e., up to 6 days) infusion during mechanical ventilation, recovery of neuromuscular function (train-of-four ratio 70%) occurred in approximately 50 (range: 20 175) or 55 (range: 20 270) minutes following infusion discontinuance. 1 Special Populations In patients with end-stage liver disease, onset may be slightly faster; however, hepatic dysfunction does not substantially alter rate of recovery from neuromuscular blockade. 1 3 6 16 In patients with renal failure, onset may be slightly delayed; however, renal dysfunction does not substantially alter rate of recovery from neuromuscular blockade. 1 3 6 16 Gender and obesity not associated with substantial changes in predicted onset or rate of recovery. 1 47 Distribution Extent Neuromuscular blocking agents generally distribute into extracellular fluid and rapidly reach site of action at motor end-plate of myoneural junction. 2 Neuromuscular blocking agents may cross placenta. 2 Volume of distribution of cisatracurium may be limited by its large molecular size and increased polarity. 47 Higher steady-state volume of distribution when nontraditional two-compartment model of elimination is used compared with a one-compartment model. 5 47 Plasma Protein Binding Plasma protein binding cannot be determined because of rapid metabolism of cisatracurium. 47 (See Elimination under Pharmacokinetics.) Special Populations Based on a one-compartment model, volume of distribution at steady-state may be increased in the elderly, ICU patients, and in patients with end-stage hepatic failure. 5 6 In burn patients, possible increased protein binding (possibly to α 1 -acid glycoprotein) of neuromuscular blocking agents with subsequent decreases in the free fraction of circulating drug. 33 34 35 37 Elimination Metabolism Rapidly metabolized via Hofmann elimination (independent of liver) to form a monoquaternary acrylate metabolite (which undergoes nonspecific plasma esterase hydrolysis and subsequent Hofmann elimination) and laudanosine (which is demethylated and glucuronidated). 1 3 6 11 14 15 19 47 Both metabolites lack neuromuscular blocking activity; laudanosine may have CNS excitatory activity when present in large amounts. 1 6 47 Rate of Hofmann elimination is dependent on temperature and pH. 1 6 15 Elimination Route Eliminated principally by Hofmann elimination (77 80%) and to lesser extent by renal and hepatic elimination (20%). 1 6 Metabolites are eliminated principally by renal and hepatic elimination. 1 Following administration of radiolabeled dose of cisatracurium to healthy individuals, 95% of administered dose is recovered in urine and 4% in feces;] FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing 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 Manufacturers Sandoz Inc. Fresenius Kabi USA, LLC Drug Class Neuromuscular blocking agents Related Drugs Anesthesia lidocaine , fentanyl , hyoscyamine , propofol , Levsin , ketamine , glycopyrrolate , Emla , Robinul , butorphanol , etomidate , succinylcholine , More... Light Anesthesia lorazepam , diazepam , Ativan , Valium , midazolam , Versed , Diastat , cisatracurium , Nimbex , Diastat AcuDial , More... Cisatracurium Rating No Reviews - Be the first! 5.0 /10 No Reviews - Be the first! 5.0 Rate it! is think about
discount Cisatracurium Besylate to explode
EmoticonEmoticon