Generic Medicine Info
Indications and Dosage
Facilitate endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 150 mcg/kg by inj. Maintenance: 30 mcg/kg by inj (each dose provides 20 min of additional block), may also be given by infusion at an initial rate of 3 mcg/kg/min followed by a rate of 1-2 mcg/kg/min.
Child: 1-23 mth Initially, 150 mcg/kg by inj over 5-10 sec, during halothane or opiate anaesth; 2-12 yr Initially, 100-150 mcg/kg by inj over 5-10 sec, during halothane or opiate anaesth. Maintenance: 20 mcg/kg by inj (each dose provides 9 min of additional block), may also be given by infusion at an initial rate of 3 mcg/kg/min followed by a rate of 1-2 mcg/kg/min.
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.
Special Precautions
Patient w/ burn injury, neuromuscular disease (e.g. myasthenia gravis, Eaton-Lambert syndrome), electrolyte abnormalities, hemiparesis or paraparesis, carcinomatosis. Childn. Pregnancy and lactation.
Adverse Reactions
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
Monitoring Parameters
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).
Drug Interactions
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: 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.
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.
Chemical Structure

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Cisatracurium besylate, CID=62886, (accessed on Jan. 21, 2020)

Store between 2-8°C. Protect from light. Do not freeze.
MIMS Class
Neuromuscular Blocking Agents
ATC Classification
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. Accessed 03/08/2015.

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

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

Disclaimer: This information is independently developed by MIMS based on Cisatracurium from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by
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