Names and pronunciation
(sis-ah-trah-kyoo′ree-um) Nimbex
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Drug reference
(sis-ah-trah-kyoo′ree-um) Nimbex
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Func. class.: Skeletal muscle relaxant
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Chem. class.: Nondepolarizing neuro- muscular blocker
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ACTION: Antagonizes acetylcholine by binding to cholinergic receptors on the motor end plate, resulting in neuromus- cular blockade
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USES: To maintain neuromuscular blockade during mechanical ventilation and as an adjunct to general anesthesia
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, benzyl alcohol hypersensitivity, electrolyte imbalances, long-term use in ICU, trauma, or burns, dehydration, metabolic alkalosis, respiratory acidosis, myopathy, myasthenia gravis
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SIDE EFFECTS CV: Bradycardia, flushing, hypotension RESP: Apnea, bronchospasm, prolonged neuromuscular block
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INTERACTIONS Increase: neuromuscular blockade— aminoglycosides, clindamycin, lithium, local anesthetics, magnesium salts, colistin, colistimethate, procainamide, quiNIDine, tetracyclines, bacitracin, capreomycin, polymyxin B, vancomycin; amphotericin B, CISplatin, corticosteroids, loop/thiazide diuretics (if hypokalemia is present) Decrease: neuromuscular blockade— carBAMazepine, phenytoin; dose of cisa- tracurium may need to be increased
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DOSAGE AND ROUTES Endotracheal intubation • Adult/adolescent (healthy): IV 0.15- 0.2 mg/kg, one time; CABG surgery with induced hypothermia use 50% of dose • Adult with myasthenia gravis: IV use peripheral nerve stimulator monitoring and an initial dose ≤0.02 mg/kg • Child 2-12 yr: IV 0.1-0.15 mg/kg over 5-10 sec during either halothane or opi- oid anesthesia • Infant/child ≤23 mo: IV 0.15 mg/kg over 5-10 sec during either halothane or opioid anesthesia To maintain neuromuscular blockade during prolonged surgical procedures: • Adult/adolescent/child ≥2 yr (heal thy): IV maintenance dose 0.03 mg/kg; C maintenance dosing is generally required 40-50 min after an initial dose of 0.15 mg/kg IV or 50-60 min after an initial dose of 0.2 mg/kg; the need for mainte- nance doses should be determined by clinical criteria; max 0.02 mg/kg/min (neuromuscular disease)
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Available forms: Injection solution 2, 10 mg/mL
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Administer: IV route • Visually inspect for particulate matter and discoloration before use • Only experienced clinicians, familiar with the use of neuromuscular blocking drugs, should administer or supervise the use of this product • Use by rapid IV injection or by con- tinuous IV infusion IV INFUSION route • Inject IV over 5-10 sec Continuous IV INFUSION route • Dilute with NS, D5W, or D5NS (0.1-0.4 mg/mL); adjust the rate of infusion ac- cording to peripheral nerve stimulation • The amount of infusion solution re- quired per minute depends on the con- centration of cisatracurium in the infusion solution, the desired dose of cisatracu- rium, and the patient’s weight • Store Nimbex injection diluted to 0.1 mg/mL either under refrigeration or at room temperature for 24 hr; dilutions to 0.1 mg/mL or 0.2 mg/mL in D5W/LR injection may be stored under refrigeration for 24 hr • Not an analgesic, treat pain with other agents
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Assess: • Neuromuscular function: use nerve stimulator to monitor neuromuscular function; if no response, stop until re- sponse; not to be used for rapid-sequence endotracheal intubation • Sedation/pain: those undergoing neu- romuscular blockage (paralytics) must receive treatment with sedative and pain control before and during therapy • Electrolytes: electrolytes and acid- base balance may be altered • Malignant hyperthermia: those with a family history of malignant hyperther- mia should not receive this product or it should be used cautiously • Pregnancy/breastfeeding: no well- controlled studies; use in pregnancy only if benefits outweigh fetal risk; use caution in breastfeeding; excretion is unknown
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Evaluate: • Maintenance of neuromuscular block- ade
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Reason for product and expected results HIGH ALERT
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PHARMACOKINETICS Onset 2 min, peak 3-5 min, duration 25-44 min, half-life 22-30 min
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• Child 2-12 yr: IV 0.1-0.15 mg/kg over 5-10 sec during either halothane or opi- oid anesthesia
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• Infant/child ≤23 mo: IV 0.15 mg/kg over 5-10 sec during either halothane or opioid anesthesia To maintain neuromuscular blockade during prolonged surgical procedures:
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• Adult/adolescent/child ≥2 yr (heal thy): IV maintenance dose 0.03 mg/kg; C maintenance dosing is generally required 40-50 min after an initial dose of 0.15 mg/kg IV or 50-60 min after an initial dose of 0.2 mg/kg; the need for mainte- nance doses should be determined by clinical criteria; max 0.02 mg/kg/min (neuromuscular disease)
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