Cisatracurium

Intravenous
Facilitate endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia

Dilute to desired concentration (e.g. 0.1-0.4 mg/mL) in a compatible IV soln (e.g. dextrose 5%, NaCl 0.9%).

Alkaline soln (e.g. thiopental Na), ketorolac trometamol, propofol injectable emulsion; lactated Ringer's inj, lactated Ringer's inj w/ dextrose 5%. Y-site: Amphotericin B sulfate complex, micafungin. Syringe: Ceftriaxone.

Patient w/ burn injury, neuromuscular disease (e.g. myasthenia gravis, Eaton-Lambert syndrome), electrolyte abnormalities, hemiparesis or paraparesis, carcinomatosis. Childn. Pregnancy and lactation.

Histamine release, wheezing, laryngospasm, bronchospasm, rash, itching, prolonged neuromuscular block, inadequate neuromuscular block, muscle weakness, myopathy, bradycardia, hypotension, flushing.
Potentially Fatal: Anaphylaxis.

IV/Parenteral: B

Monitor heart rate, BP, resp rate; peripheral nerve stimulator twitch response (when appropriate).

Symptoms: Prolonged muscle paralysis. Management: Maintain pulmonary ventilation and arterial oxygenation. Recovery may be accelerated by admin of anti-cholinesterase agent (e.g. neostigmine, edrophonium).

Increased effect w/ anaesth agents (e.g. enflurane, isoflurane, halothane, ketamine), other non-depolarising neuromuscular blocking agents, certain antibiotics (e.g. aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin, clindamycin), anti-arrhythmic drugs (e.g. propranolol, Ca channel blockers, lidocaine, procainamide, quinidine), diuretics (e.g. furosemide, and possibly thiazides, mannitol and acetazolamide), Mg and lithium salts, ganglion blocking drugs (e.g. trimetaphan, hexamethonium). Decreased effect w/ phenytoin, carbamazepine, anticholinesterases (e.g. donepezil).

Description:
Mechanism of Action: Cisatracurium antagonises the action of acetylcholine by binding to cholinergic receptors on the motor end-plate, resulting in a competitive block of neuromuscular transmission.
Onset: 2-3 min.
Pharmacokinetics:
Absorption: Time to peak plasma concentration: 3-5 min.
Distribution: Distributed into extracellular fluid and crosses the placenta. Volume of distribution: 121-161 mL/kg.
Metabolism: Converted to laudanosine and monoquaternary acrylate metabolite by spontaneous degradation via Hofmann elimination. The monoquaternary acrylate undergoes ester hydrolysis by non-specific plasma esterases.
Excretion: Via urine and bile, mostly as metabolites. Half-life: 22-29 min.

Source: National Center for Biotechnology Information. PubChem Database. Cisatracurium besylate, CID=62886, https://pubchem.ncbi.nlm.nih.gov/compound/Cisatracurium-besylate (accessed on Jan. 21, 2020)

Store between 2-8°C. Protect from light. Do not freeze.

Neuromuscular Blocking Agents

M03AC11 - cisatracurium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

Anon. Cisatracurium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/08/2015.

Buckingham R (ed). Atracurium Besilate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/08/2015.

Cisatracurium Besylate Injection, Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/08/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Cisatracurium Besylate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 03/08/2015.