Cisatricurium

Administration

  • Type: Neuromuscular blocker
  • Dosage Forms: Injection
  • Routes of Administration: IV
  • Common Trade Names: Nimbex

Adult Dosing

  • Induction
    • 150-200 mcg/kg IV x 1
  • Maintenance
    • Intermittent
      • 30 mcg/kg IV q20 min PRN (Start ~50 min after induction dose)
    • Continuous
      • 1-2 mcg/kg/min IV (though rates may vary widely)

Pediatric Dosing

  • Induction
    • 1-23 months: 150 mcg/kg IVx1
    • 2-12 years old: 100-150 mcg/kg IV x1
    • >12 years old: 150-200 mcg/kg IV x1
  • Maintenance
    • >2 years old: 1-2 mcg/kg min (though rates may vary widely)

Special Populations

Pregnancy Rating

  • Caution advised, insufficient data

Lactation risk

  • Caution advised, insufficient data

Renal Dosing

  • Adult: Not defined, consider extended interval between dose administration and intubation if ESRD
  • Pediatric: Not defined, consider extended interval between dose administration and intubation if ESRD

Hepatic Dosing

  • Adult: Not defined, onset 1 minute faster than healthy controls
  • Pediatric: Not defined, onset 1 minute faster than healthy controls

Contraindications

  • Allergy to class/drug
  • Neonates (benzyl alcohol-containing forms)
  • Caution if neuromuscular disease, burns, asthma, electrolyte abnormalities

Adverse Reactions

Serious

Common

  • Bradycardia
  • Hypotension
  • Flushing
  • Bronchospasm
  • Rash

Pharmacology

  • Half-life: 22-29 minutes
  • Metabolism: Liver
  • Excretion: Urine

Mechanism of Action

  • Binds to motor end-plate cholinergic receptor, antagonizing acetylcholine activity and producing neuromuscular blockade

Comments

Cisatricurium can also be used as adjunct therapy for ARDS. Clinical practice guidelines recommend a short course for patients with early sepsis-related ARDS with a PaO2/FiO2 less than 150 mmHg.[1]

See Also

References

  1. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–1116. doi:10.1056/NEJMoa1005372