Home Drug Guide Cisatracurium Besylate

Drug Guide

Generic Name

Cisatracurium Besylate

Brand Names Nimbex, Nimbex Preservative Free, Cisatracurium Besylate Preservative Free

Classification

Therapeutic: Muscle Relaxant (Skeletal Muscle Blocker)

Pharmacological: Non-depolarizing Neuromuscular Blocking Agent

FDA Approved Indications

Adjunct to general anesthesia to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Mechanism of Action

Cisatracurium is a non-depolarizing neuromuscular blocking agent that works by competitively binding to acetylcholine receptors at the neuromuscular junction, preventing depolarization and inducing muscle relaxation.

Dosage and Administration

Adult: Initial dose: 0.15-0.2 mg/kg IV; subsequent doses based on clinical response, typically 0.03-0.1 mg/kg as needed.

Pediatric: Dosing is similar to adults; titrated based on neuromuscular blockade monitoring.

Geriatric: Start at lower end of dosing range; monitor closely due to potential increased sensitivity.

Renal Impairment: Adjustment may be necessary; consult specific guidelines.

Hepatic Impairment: No specific adjustment required.

Pharmacokinetics

Absorption: IV administration only.

Distribution: Widely distributed in tissues, minimal crossing of blood-brain barrier.

Metabolism: Hepatic and plasma esterases degrade cisatracurium.

Excretion: Primarily eliminated via Hofmann elimination and ester hydrolysis, no active metabolites.

Half Life: 20-35 minutes.

Contraindications

Known hypersensitivity to cisatracurium or other related compounds.

Precautions

Use with caution in patients with neuromuscular diseases (e.g., myasthenia gravis), electrolyte imbalances (especially hypokalemia, hypocalcemia), or severe burns. Continuous neuromuscular monitoring is recommended.

Adverse Reactions - Common

Transient hypotension (Less common)
Flushing (Less common)
Dyspnea or bronchospasm (Uncommon)

Adverse Reactions - Serious

Malignant hyperthermia (Rare)
Prolonged paralysis or apnea due to excessive dosing or altered metabolism (Rare)

Drug-Drug Interactions

Potassium-depleting agents (e.g., diuretics), other muscle relaxants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor neuromuscular function using a peripheral nerve stimulator (e.g., train-of-four). Assess for signs of inadequate paralysis or prolonged blockade.

Diagnoses:

Risk for impaired gas exchange
Ineffective airway clearance

Implementation: Administer as ordered; ensure resuscitative equipment is available. Monitor vital signs and neuromuscular response.

Evaluation: Assess for adequate paralysis and muscle relaxation; monitor for adverse reactions.

Patient/Family Teaching

Explain that the medication causes muscle weakness and breathing difficulty temporarily.
Inform about the importance of monitoring during anesthesia and the potential for muscle weakness afterward.

Special Considerations

Black Box Warnings:

Prolonged paralysis and respiratory depression can occur if dosing is inappropriate or if patient has conditions affecting drug metabolism.

Genetic Factors: None specific.

Lab Test Interference: Potential interference with neuromuscular function assessments.

Overdose Management

Signs/Symptoms: Persistent neuromuscular blockade, respiratory depression, apnea.

Treatment: Supportive airway management, mechanical ventilation, administration of reversal agents if applicable (though specific reversal for cisatracurium is limited; supportive care is primary).

Storage and Handling

Storage: Store at controlled room temperature (20-25°C, 68-77°F).

Stability: Stable for the duration of the labeled expiration date when stored properly.