Cisatracurium

Cisatracurium Brand Name– Nimbex

What is Cisatracurium

Cisatracurium is a parenteral, intermediate-acting, nondepolarizing, neuromuscular blocking agent (NMBA) indicated as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

The majority of cisatracurium is metabolized via spontaneous degradation (Hofmann elimination); the liver and kidney play a minor role in the elimination of cisatracurium but are the primary pathways for the elimination of metabolites, including laudanosine.

Cisatracurium is the cis-cis isomer of atracurium; it is similar to atracurium, but the absence of both short and long half-life isomers results in a more predictable therapeutic agent, with approximately 4 times the potency of the racemic mixture.

Cisatracurium has minor histamine-releasing properties

Indications

  1. acute respiratory distress syndrome (ARDS)
  2. endotracheal intubation
  3. neuromuscular blockade during mechanical ventilation
  4. neuromuscular blockade during surgery
  5. shaking chills

Side Effects

  1. acute quadriplegic myopathy syndrome
  2. anaphylactoid reactions
  3. angioedema
  4. anxiety
  5. apnea
  6. bradycardia
  7. bronchospasm
  8. conjunctivitis
  9. dyspnea
  10. erythema
  11. flushing
  12. hypotension
  13. hypoxia
  14. keratitis
  15. laryngospasm
  16. malignant hyperthermia
  17. muscle paralysis
  18. myopathy
  19. pruritus
  20. rash
  21. respiratory depression
  22. seizures
  23. sinus tachycardia
  24. skin erosion
  25. skin ulcer
  26. thrombosis
  27. tolerance
  28. urticaria
  29. weakness
  30. wheezing
  31. xerophthalmia

Monitoring Parameters

  • peripheral nerve stimulation

Contraindications

  • accidental exposure
  • acid/base imbalance
  • adrenal insufficiency
  • asthma
  • breast-feeding
  • burns
  • chronic lung disease (CLD)
  • chronic obstructive pulmonary disease (COPD)
  • dehydration
  • electrolyte imbalance
  • geriatric
  • hepatic disease
  • hypercalcemia
  • hypermagnesemia
  • hypocalcemia
  • hypokalemia
  • hypothermia
  • infection
  • malignant hyperthermia
  • metabolic acidosis
  • metabolic alkalosis
  • myasthenia gravis
  • neonates
  • neuromuscular blocking agent hypersensitivity
  • neuromuscular disease
  • obesity
  • pregnancy
  • premature neonates
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • requires a specialized care setting
  • requires an experienced clinician
  • respiratory acidosis
  • respiratory alkalosis

Interactions

  • Acebutolol
  • Acetazolamide
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Amide local anesthetics
  • Aminoglycosides
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Atenolol
  • Atenolol; Chlorthalidone
  • Bacitracin
  • Bendroflumethiazide; Nadolol
  • Beta-blockers
  • Betaxolol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Botulinum Toxins
  • Brimonidine; Timolol
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium-channel blockers
  • Calcium; Vitamin D
  • Capreomycin
  • Carbonic anhydrase inhibitors
  • Carteolol
  • Carvedilol
  • Chromium
  • Clevidipine
  • Colistimethate, Colistin, Polymyxin E
  • Corticosteroids
  • Cyclophosphamide
  • Cyclosporine
  • Demeclocycline
  • Desflurane
  • Dextromethorphan; Quinidine
  • Diltiazem
  • Donepezil
  • Donepezil; Memantine
  • Dorzolamide; Timolol
  • Doxycycline
  • Enalapril; Felodipine
  • Enflurane
  • Esmolol
  • Ester local anesthetics
  • Felodipine
  • Fosphenytoin
  • Galantamine
  • Hetastarch; Dextrose; Electrolytes
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Indapamide
  • Irinotecan
  • Irinotecan Liposomal
  • Isoflurane
  • Isradipine
  • Ketorolac
  • Labetalol
  • Levobetaxolol
  • Levobunolol
  • Lincosamides
  • Lithium
  • Loop diuretics
  • Magnesium
  • Methazolamide
  • Metoprolol
  • Minocycline
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Neostigmine
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nisoldipine
  • Omadacycline
  • Penbutolol
  • Perindopril; Amlodipine
  • Phenytoin
  • Physostigmine
  • Pindolol
  • Piperacillin
  • Piperacillin; Tazobactam
  • Polymyxin B
  • Polymyxins
  • Procainamide
  • Propranolol
  • Pyridostigmine
  • Quinidine
  • Quinine
  • Ranitidine
  • Rivastigmine
  • Sarecycline
  • Sevoflurane
  • Sotalol
  • Succinylcholine
  • Tetracycline
  • Tetracyclines
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Timolol
  • Trandolapril; Verapamil
  • Vancomycin
  • Verapamil
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