Cisatracurium

Administration

• Type: Neuromuscular blocker, Non-depolarizing
• Dosage Forms: Injection (2mg/mL, 10mg/mL)
• Routes of Administration: IV
• Common Trade Names: Nimbex

Adult Dosing

General

• Intubation: 0.15-0.2mg/kg IV
• Maintenance: 0.03mg/kg IV q20min PRN, or 1-3mcg/kg/min infusion

Indications by Condition

Indication	Dose	Context	Route	Population
Acute respiratory distress syndrome	0.15mg/kg load, then 1-3mcg/kg/min	Neuromuscular blockade to prevent barotrauma/vent dyssynchrony	IV	Adult

Pediatric Dosing

General

• Intubation: 0.1-0.15mg/kg IV
• Maintenance: 1-2mcg/kg/min infusion

Special Populations

• Pregnancy Rating: B
• Lactation risk: Not defined

Renal Dosing

• No adjustment required (Hofmann elimination)

Hepatic Dosing

• No adjustment required

Contraindications

• Allergy to class/drug
• Caution with myasthenia gravis

Adverse Drug Reactions

Serious

• Prolonged paralysis
• Bronchospasm (rare)

Common

• Flushing
• Bradycardia

Pharmacology

• Onset of action: 2-3 minutes
• Duration: 40-60 minutes
• Half-life: 22-29 minutes
• Metabolism: Hofmann elimination (organ-independent)
• Excretion: Renal and biliary

Mechanism of Action

• Competitive antagonist at nicotinic acetylcholine receptors at the neuromuscular junction
• Undergoes Hofmann elimination (spontaneous degradation at physiologic pH and temperature)

See Also

• Rapid sequence intubation
• Neuromuscular blocking agents
• Rocuronium
• Vecuronium