Cisatracurium
Cisatracurium Uses, Dosage, Side Effects, Mechanism of Action, How Long Does it Take to Work? Cisatracurium is a brand name. Its generic name is Cisatracurium.
Cisatracurium Introduction
Cisatracurium is an intravenous neuromuscular blocking drugs (NMBDs) for muscle relaxation during anesthesia and mechanical ventilation. It belongs to a class of drugs known as non-depolarizing NMBDs, which are used to prevent and treat muscle spasms during a medical procedure. Cisatracurium is indicated for use as an adjunct to general anesthesia, to facilitate both tracheal intubation and mechanical ventilation.
Uses of Cisatracurium
Cisatracurium is indicated for use as an adjunct to general anesthesia, to facilitate tracheal intubation and muscle relaxation during mechanical ventilation. Induction of anesthesia is an important step in perioperative management, and muscle relaxation is an integral part of it. Cisatracurium is also used for muscle relaxation during newborn resuscitation.
Mechanism of Action
Cisatracurium works by blocking the response of the motor end plate to acetylcholine, which is a neurotransmitter. It does this by preventing the binding of acetylcholine to the receptor on the muscle end plate. This prevents the muscle from receiving signals from the nervous system, thus relaxing the muscle.
How Long Does it Take to Work?
Cisatracurium generally takes between 1 and 2 minutes to begin working. After it is administered, its onset time depends on the dose, route of administration and several other factors. After the drug is started, its effects can last anywhere from 5 to 20 minutes, depending on the dose and route of administration.
Absorption
Cisatracurium is not orally administered; it is instead administered intravenously. This means that it does not undergo any absorption into the body before entering the bloodstream. As a result, most of the drug is available to the muscles upon reaching the bloodstream.
Route of Elimination
Cisatracurium is eliminated from the body primarily by urinary excretion. It is metabolized in the liver and broken down into metabolites before being excreted in the urine. The metabolites of cisatracurium are also excreted in the bile.
Dosage
The usual dosage of cisatracurium is 0.2 to 0.4 mg/kg intravenously for muscle relaxation during anesthesia. The maintenance dosage is 0.1 to 0.2 mg/kg. The dosage may vary depending on the patient's age, weight, and medical condition.
Administration
Cisatracurium is available in a solution form for intravenous administration. It should be administered under medical supervision, slowly over 15 to 30 seconds. It can be mixed with an equal volume of compatible diluent such as normal saline or 5% dextrose/sterile water before being administered.
Side Effects
The most common side effects of cisatracurium are hypotension (low blood pressure), bradycardia (slow heart rate), nausea, vomiting, and dizziness. Other side effects can include respiratory depression, allergic reactions, malignant hyperthermia, and anaphylaxis. It should be noted that cisatracurium should not be administered to patients with myasthenia gravis, as it may worsen the condition.
Toxicity
Cisatracurium has a low risk of toxicity when used at recommended doses. However, overdose can lead to serious neurotoxicity, including severe weakness, muscle twitching, and muscle paralysis. If an overdose is suspected, medical attention should be sought immediately.
Precautions
Cisatracurium should be used with caution in patients with compromised cardiovascular or respiratory function, and those with known hypersensitivity to neuromuscular blockers. Patients with myasthenia gravis should not be administered cisatracurium.
Interaction
Cisatracurium can interact with a variety of drugs, including anticholinergics, opioids, barbiturates, and tricyclic antidepressants. It should not be administered with other neuromuscular blockers, as this may increase the risk of adverse effects.
Disease Interaction
Cisatracurium should be used with caution in patients with hepatic or renal impairment, as well as those with myasthenia gravis. It should also be used with caution in patients with electrolyte imbalances, acid-base imbalances or hyperkalemia.
Drug Interaction
Cisatracurium may interact with a variety of drugs, including anticholinergics, opioids, barbiturates, and tricyclic antidepressants. It should not be administered with other neuromuscular blockers, as this may increase the risk of adverse effects.
Food Interactions
Cisatracurium is not known to interact with any foods. However, it should not be taken with alcohol or grapefruit juice, as these can decrease its effectiveness.
Pregnancy Use
Cisatracurium should only be used during pregnancy when clearly needed. Animal studies have not demonstrated any teratogenic, carcinogenic, or mutagenic effects, however, there is limited data on its use in pregnant women.
Lactation Use
Cisatracurium is not known to be excreted in breast milk. However, it should be used with caution in nursing mothers, as there is limited data regarding its safety during lactation.
Acute Overdose
An acute overdose of cisatracurium can lead to serious neurotoxicity, including severe weakness, muscle twitching, and muscle paralysis. It can also cause cardiorespiratory depression, which may lead to respiratory failure and death. Medical attention should be sought immediately if an overdose is suspected.
Contraindication
Cisatracurium is contraindicated in patients with myasthenia gravis, as it may worsen the condition. It should also be used carefully in patients with impaired cardiovascular or renal function, as well as those with known hypersensitivity to neuromuscular blockers.
Use Direction
Cisatracurium should be administered intravenously in a dose of 0.2 to 0.4 mg/kg to induce muscle relaxation. It should not be administered intramuscularly, as this may lead to unpredictable effects. It should also be administered slowly over 15 to 30 seconds under medical supervision.
Storage Condition
Cisatracurium should be stored at room temperature away from light and moisture. It should always be reconstituted immediately before use and should not be stored after reconstitution.
Volume of Distribution
The volume of distribution of cisatracurium is 0.5 L/kg. This means that the drug distributes into 0.5 liters of body fluids per kilogram of the patient's body weight.
Half Life
The half life of cisatracurium is approximately 8 minutes. This is the time it takes for the amount of drug in the body to be reduced by half.
Clearance
The clearance of cisatracurium is 20 mL/minute/kg. This is the amount of drug that is removed from the body in a given time period.
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