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
- acute respiratory distress syndrome (ARDS)
- endotracheal intubation
- neuromuscular blockade during mechanical ventilation
- neuromuscular blockade during surgery
- shaking chills
Side Effects
- acute quadriplegic myopathy syndrome
- anaphylactoid reactions
- angioedema
- anxiety
- apnea
- bradycardia
- bronchospasm
- conjunctivitis
- dyspnea
- erythema
- flushing
- hypotension
- hypoxia
- keratitis
- laryngospasm
- malignant hyperthermia
- muscle paralysis
- myopathy
- pruritus
- rash
- respiratory depression
- seizures
- sinus tachycardia
- skin erosion
- skin ulcer
- thrombosis
- tolerance
- urticaria
- weakness
- wheezing
- 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
