Cisatracurium injection
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for injection containing cisatracurium besilate.
Drugs List
Therapeutic Indications
Uses
Neuromuscular blockade to aid intubation and mechanical ventilation in ITU
Neuromuscular blockade to facilitate intubation during surgery
Dosage
Due to the complexity and specialist nature of using anaesthesia, specific dosing information on this agent is not included.
When using this agent, specialist literature, national guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of all relevant patient factors.
During treatment, monitoring of neuromuscular function is recommended to guide individual dose requirements.
Adults
Induction of neuromuscular block
Neuromuscular block is induced with a single dose of cisatracurium. The dose is individualised based on patient weight and choice of anaesthetic background, in addition to other factors.
Use of a higher dose will shorten the time to onset of neuromuscular block.
Maintenance of neuromuscular block
Neuromuscular block is maintained with either consecutive doses administered at regular intervals or the use of a continuous infusion.
Use of consecutive doses will not progressively prolong the effects, maintenance can continue for as long as the procedure requires neuromuscular block.
Recovery or reversal of neuromuscular block
Following discontinuation of treatment, spontaneous recovery from neuromuscular block will develop. Once underway, the rate of recovery is independent of the dose of cisatracurium used.
Where needed, standard doses of anticholinesterase agents can be used to readily reverse the effects.
Elderly
Onset of action may be slower. No dose modifications are recommended.
Children
Children aged 1 month to 18 years
Induction of neuromuscular block
Neuromuscular block is induced with a single dose of cisatracurium. The dose is individualised based on patient weight and choice of anaesthetic background, in addition to other factors.
Use of a higher dose will shorten the time to onset of neuromuscular block.
Maintenance of neuromuscular block
Neuromuscular block is maintained with either consecutive doses administered at regular intervals or the use of a continuous infusion.
Use of consecutive doses will not progressively prolong the effects, maintenance can continue for as long as the procedure requires neuromuscular block.
Recovery or reversal of neuromuscular block
Following discontinuation of treatment, spontaneous recovery from neuromuscular block will develop. Once underway, the rate of recovery is independent of the dose of cisatracurium used.
Where needed, standard doses of anticholinesterase agents can be used to readily reverse the effects.
Children aged 1 month to 12 years
A shorter duration of action and/or a faster rate of spontaneous recovery may be seen. Monitor neuromuscular function closely.
Patients with Renal Impairment
Onset of action may be slower. No dose modifications are recommended.
Patients with Hepatic Impairment
Onset of action may be faster. No dose modifications are recommended.
Administration
Do not administer through the same infusion line as blood products, propofol injectable emulsion or alkaline solutions (e.g. sodium thiopentone).
Induction of neuromuscular block
Intravenous injection.
Maintenance of neuromuscular block
Intravenous injections repeated at regular intervals or continuous intravenous infusion.
Contraindications
Neonates
Pregnancy
Precautions and Warnings
Burns
Hypothermia
Obesity
Predisposition to seizures
Breastfeeding
Cardiovascular disorder
Disorder of acid-base balance
Electrolyte imbalance
Myasthenia gravis
Neuromuscular disorder
Anticholinesterase should be immediately available to reverse blockade
Consider reducing initial dose in myasthenia gravis
Ventilation should be controlled by anaesthetist
Preservative free. Rigorous aseptic technique necessary.
Do not give blood products in same intravenous line
Do not mix with other drugs/substances unless compatibility known
Do not use if solution is discoloured or particulates are apparent
For single use only
Incompatible with sodium bicarbonate and other alkaline substances
To be administered by anaesthetist or a doctor trained in intensive care
Ventilatory support facilities must be immediately available
Monitor neuromuscular block & recovery using a peripheral nerve stimulator
In obese patients dosing should be based on ideal weight
Breastfeeding: Do not breastfeed & discard milk for 3 hours after treatment
Cisatracurium should be used alongside adequate general anaesthesia and/or sedatives. It has no known effect on consciousness or pain threshold.
Cisatracurium has no effect on heart rate so will not counteract any bradycardia caused by anaesthetic agents or vagal stimulation during surgery.
Experience of using high doses in patients with cardiovascular disease is limited. Reduced administration rates may be required.
Experience in children (all ages) undergoing cardiac surgery, in children aged 1 month to 12 years undergoing major or prolonged surgery and in children with an American Society of Anaesthesiologists (ASA) classification of III-IV undergoing tracheal intubation is limited. Use cisatracurium with caution in these patients.
Dose modifications and/or closer monitoring may be required in patients with myasthenia gravis, patients with other neuromuscular disorders, patients with burns, patients undergoing surgery with induced hypothermia and patients with acid-base and/or electrolyte abnormalities.
Pregnancy and Lactation
Pregnancy
Cisatracurium is contraindicated during pregnancy.
Use of cisatracurium during pregnancy is contraindicated by the manufacturer. At the time of writing there is limited published information regarding the use of cisatracurium during pregnancy. Cisatracurium has a high molecular weight and is highly ionized at physiological pH which theoretically will limit placental passage. Potential risks are unknown.
Lactation
Use cisatracurium with caution during breastfeeding.
The manufacturer does not recommend breastfeeding whilst taking cisatracurium. Presence of cisatracurium in human breastmilk is unknown. Effects on exposed infants are unknown.
Breastfeeding should be discontinued during treatment and for 3 hours after the last dose or end of infusion. All breast milk expressed during this period should be discarded.
Side Effects
Anaphylactic reaction
Bradycardia
Bronchospasm
Circulatory collapse
Flushing
Hypotension
Muscle weakness
Myopathy
Rash
Shock
Skin reactions
Tachycardia
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: October 2017
Reference Sources
Summary of Product Characteristics: Cisatracurium 2mg/ml Solution for Injection/Infusion. AS Kalceks. Revised November 2021.
Summary of Product Characteristics: Cisatracurium injection 2mg/ml. Hospira UK. Revised April 2017.
Summary of Product Characteristics: Cisatracurium injection 5mg/ml. Accord Healthcare Ltd. Revised November 2014.
Summary of Product Characteristics: Cisatracurium injection 5mg/ml. Hospira UK. Revised April 2017.
Summary of Product Characteristics: Nimbex injection 2mg/ml. Aspen. Revised August 2017.
Summary of Product Characteristics: Nimbex Forte injection 5mg/ml. Aspen. Revised August 2017.
NICE Evidence Services
Available at: www.nice.org.uk
Last accessed: 14 July 2022.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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