cisatracurium besilate: clinical use

Prescribing considerations

• Administer only by or under clinicians experienced with neuromuscular blockade, with immediate access to intubation, ventilation and oxygenation facilities.
• Provide adequate general anaesthesia or sedation because cisatracurium does not impair consciousness or pain perception.
• Use objective neuromuscular monitoring to individualise administration and confirm recovery.
• Consider cross-sensitivity after a reaction to another neuromuscular blocker.

Contraindications and cautions

• Hypersensitivity to cisatracurium, atracurium, benzenesulfonic acid or another formulation excipient.
• Use particular caution with myasthenia gravis or other neuromuscular disease, major acid-base or electrolyte abnormalities, burns, previous neuromuscular-blocker allergy and induced hypothermia.
• Not recommended for neonates because this population has not been studied.
• Do not administer through a blood-transfusion line because the solution is hypotonic.

Monitoring

• Peripheral nerve-stimulator response and clinical recovery
• Airway patency, ventilation and arterial oxygenation
• Heart rate and blood pressure
• Signs of anaphylaxis or bronchospasm
• Persistent weakness or myopathy during prolonged intensive-care use

Clinical pharmacology

Cisatracurium competitively blocks acetylcholine at nicotinic receptors on the motor end plate. It undergoes largely organ-independent Hofmann elimination at physiological pH and temperature. Its metabolites lack neuromuscular-blocking activity, although concentrations may rise with renal or hepatic dysfunction.

Formulation and product differences

• Clear, colourless or yellowish acidic solution for intravenous injection or infusion in single-use glass ampoules.
• Contains benzenesulfonic acid for pH adjustment and water for injections, without an antimicrobial preservative.
• Store refrigerated, protect from light and do not freeze.
• Do not mix with alkaline solutions, propofol injectable emulsion or ketorolac. Lactated Ringer's-containing solutions are unsuitable diluents.

Injection

Route: Parenteral

Strengths: 2 mg/mL, 5 mg/mL