Chemical formula: C₆₅H₈₂N₂O₁₈S₂ Molecular mass: 929.16 g/mol PubChem compound: 62886
Cisatracurium interacts in the following cases:
No dosing alterations are required in patients with renal failure.
In these patients cisatracurium has a similar pharmacodynamic profile to that observed in patients with normal renal function but it may have a slightly slower onset.
No dosing alterations are required in patients with end-stage liver disease. In these patients Nimbex has a similar pharmacodynamic profile to that observed in patients with normal hepatic function but it may have a slightly faster onset.
Rarely, certain drugs may aggravate or unmask latent myasthenia gravis or actually induce a myasthenic syndrome; increased sensitivity to non-depolarising neuromuscular blocking agents might result. Such drugs include various antibiotics, b-blockers (propranolol, oxprenolol), anti-arrhythmic drugs (procainamide, quinidine), anti-rheumatic drugs (chloroquine, D-penicillamine), trimetaphan, chlorpromazine, steroids, phenytoin and lithium.
Treatment with anticholinesterases, commonly used in the treatment of Alzheimer’s disease e.g. donepezil, may shorten the duration and diminish the magnitude of neuromuscular blockade with cisatracurium.
Many drugs have been shown to influence the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents.
Increased effect by anaesthetic agents such as enflurane, isoflurane, halothane and ketamine, by other non-depolarising neuromuscular blocking agents or by other drugs such as antibiotics (including the aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin and clindamycin), anti-arrhythmic drugs (including propranolol, calcium channel blockers, lidocaine, procainamide and quinidine), diuretics, (including furosemide and possibly thiazides, mannitol and acetazolamide), magnesium and lithium salts and ganglion blocking drugs (trimetaphan, hexamethonium).
A decreased effect is seen after prior chronic administration of phenytoin or carbamazepine.
Administration of suxamethonium to prolong the effects of non-depolarising neuromuscular blocking agents may result in a prolonged and complex block which can be difficult to reverse with anticholinesterases.
Prior administration of suxamethonium has no effect on the duration of neuromuscular block following bolus doses of cisatracurium or on infusion rate requirements.
Cisatracurium has not been studied in patients with burns; however, as with other non-depolarising neuromuscular blocking agents, the possibility of increased dosing requirements and shortened duration of action must be considered if cisatracurium injection is administered to these patients.
There are no adequate data from the use of cisatracurium in pregnant women. Animal studies are insufficient with respect to effects on pregnancy, embryonal/foetal development, parturition and postnatal development. The potential risk for humans is unknown.
Cisatracurium should not be used during pregnancy.
It is not known whether cisatracurium or its metabolites are excreted in human milk.
A risk to the breastfed infant cannot be excluded. However, due to the short half-life, an influence on the breastfed infant is not to be expected if the mother restarts breast-feeding after the effects of the substance have worn off. As a precaution breast-feeding should be discontinued during treatment for at least five elimination half-lives of cisatracurium, i.e. for about 3 hours after the last dose or the end of infusion of cisatracurium.
Fertility studies have not been performed.
This precaution is not relevant to the use of cisatracurium. Cisatracurium will always be used in combination with a general anaesthetic and therefore the usual precautions relating to performance of tasks following general anaesthesia apply.
Data from pooled internal clinical trials were used to determine the frequency of very common to uncommon adverse reactions.
The following convention has been used for the classification of frequency:- very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1000 to <1/100), rare (≥1/10,000 to <1/1000), very rare (<1/10,000).
Clinical Trial Data:
Common: Bradycardia
Common: Hypotension
Uncommon: Cutaneous flushing
Uncommon: Bronchospasm
Uncommon: Rash
Postmarketing Data
Very rare: Anaphylactic reaction, Anaphylactic shock
Anaphylactic reactions of varying degrees of severity have been observed after the administration of neuromuscular blocking agents, including anaphylactic shock. Very rarely, severe anaphylactic reactions have been reported in patients receiving cisatracurium in conjunction with one or more anaesthetic agents.
Very rare: Myopathy, muscle weakness
There have been some reports of muscle/weakness and/or myopathy following prolonged use of muscle relaxants in severely ill patients in the ICU. Most patients were receiving concomitant corticosteroids. These events have been reported infrequently in association with cisatracurium and a causal relationship has not been established.
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