Cisatracurium Besilate

Registered South African indications:

• Muscle relaxation

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients

Cautions

• Pregnancy
• Breastfeeding
• Myasthenia gravis
• Electrolyte abnormalities
• Neonates
• Burns
• Coadministration with blood transfusion/s

Forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

• IV: 0.15mg/kg, as a bolus injection 

Maintenance of muscle relaxation for surgical procedures

• IV: 0.03mg/kg, as a bolus injection
• IV: Initial: 3μg/kg/min (0.18mg/kg/hr), as an infusion; Then reduce to 1-2μg/kg/min (0.06-0.12mg/kg/hr)

Paed. forms avail. in SA and covered in this monograph: inj

Endotracheal intubation 

Younger than 1 month

• Not established for use

Older than 1 month

• See adult dosage

Maintenance of muscle relaxation for surgical procedures

Younger than 2 years

• Not established for use

Between 2-12 years

• IV bolus: 0.02mg/kg
• IV infusion: See adult dosage

Older than 12 years

• See adult dosage

Pregnancy

• Caution
• There is insufficient data on 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

Breastfeeding

• Caution
• It is not known whether cisatracurium or its metabolites are excreted in human milk. A risk to the breastfeeding child cannot be excluded. Due to the short half-life, an influence on the breastfeeding child is not to be expected if the mother restarts breastfeeding after the effects of the substance have worn off. As a precaution breastfeeding should be discontinued during treatment and for at least 12 hours after administration of this medicinal product

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Cardiovascular Disorders

• Bradycardia
• Hypotension
• Cutaneous flushing

Respiratory Disorders

• Bronchospasm

Musculoskeletal Disorders

• Myopathy 
• Muscle weakness

Skin and Subcutaneous Disorders

• Rash

Immune System Disorders

• Anaphylactic reaction

• Enflurane
• Isoflurane
• Halothane
• Ketamine
• Aminoglycosides
• Polymyxins
• Spectinomycin
• Tetracyclines
• Linomycin
• Clindamycin
• Propranolol
• Calcium channel blockers
• Lignocaine
• Procainamide
• Quinidine
• Diuretics
• Magnesium salts
• Ganglion blocking agents
• Phenytoin
• Carbamazepine
• Anticholinesterases
• Chloroquine
• D-penicillamine
• Trimetaphan
• Chlorpromazine
• Steroids
• Lithium

None routine

Cisatracurium besilate binds to the nicotinic acetycholine receptors in the motor endplate and blocks access to the receptors. In the process of binding, the receptor is activated, resulting in depolarization. Since it is not degraded in the neuromuscular junction, the depolarized membrane remains depolarized and unresponsive to any other impulse, causing muscle paralysis.

Injection (per ml) 2mg

• Nimbex (Pharmacare) originator

Injection (per ml) 5mg

• Nimbex (Pharmacare) originator

Infusion (per 2ml) 5mg

• Cistrax (Accord)

Injection (per 2.5ml) 5mg

• Cisatracurium Safeline (Safeline)

Infusion (per 5ml) 10mg

• Cistrax (Accord)

Injection (per 5ml) 10mg

• Cisatracurium 10mg/5ml Fresenius (Fresenius Kabi SA)
• Cisatracurium Safeline (Safeline)

Injection (per 10ml) 20mg

• Cisatracurium Safeline (Safeline)

Infusion (per 30ml) 150mg

• Cistrax (Accord)