Pharmacotherapeutic group: muscle relaxants, peripherally acting agents, other quaternary ammonium compounds, ATC code: M03AC11
Cisatracurium is an intermediate-duration, non-depolarising benzylisoquinolinium skeletal muscle relaxant.
Mechanism of action
Clinical studies in man indicated that cisatracurium is not associated with dose dependent histamine release even at doses up to and including 8 x ED
95
.
Cisatracurium binds to cholinergic receptors on the motor end-plate to antagonise the action of acetylcholine, resulting in a competitive block of neuromuscular transmission. This action is readily reversed by anticholinesterase agents such as neostigmine or edrophonium.
The ED
95
(dose required to produce 95% depression of the twitch response of the adductor pollicis muscle to stimulation of the ulnar nerve) of cisatracurium is estimated to be 0.05 mg/kg bodyweight during opioid anaesthesia (thiopentone/fentanyl/midazolam).
The ED
95
of cisatracurium in children during halothane anaesthesia is 0.04 mg/kg.
⚠️ Warnings
For single use only.
The medicinal product should be used immediately after opening the ampoule.
The medicinal product should be visually inspected prior to use. This medicine should not be used if there are any visible signs of deterioration (e.g. particles).
Diluted Cisatracurium solution is physically and chemically stable for at least 24 hours at 5ºC and 25ºC at concentrations between 0.1 mg/ml and 1.5 mg/ml in the following infusion fluids when in contact with polypropylene or polycarbonate syringes, polyethylene or PVC tubing, and polypropylene or PVC infusion bags:
‒ sodium chloride 0.9% solution;
‒ glucose 5% solution;
‒ sodium chloride 0.18% and glucose 4% solution;
‒ sodium chloride 0.45% and glucose 2.5% solution.
Cisatracurium has been shown to be compatible with the following commonly used perioperative drugs, when mixed in conditions simulating administration into a running intravenous infusion via a Y-site injection port: alfentanil hydrochloride, droperidol, fentanyl citrate, midazolam hydrochloride and sufentanil citrate.
Where other drugs are administered through the same needle or cannula as cisatracurium, it is recommended that each drug be flushed through with an adequate volume of a suitable intravenous fluid, e.g. sodium chloride 0.9% solution.
As with other drugs administered intravenously, when a small vein is selected as the injection site, cisatracurium should be flushed through the vein with a suitable intravenous fluid, e.g. sodium chloride 0.9% solution.
Instruction of ampoule opening:
1) Turn the ampoule with coloured point up. If there is any solution in the upper part of the ampoule, gently tap with your finger to get all the solution to the lower part of the ampoule.
2) Use both hands to open; while holding the lower part of the ampoule in one hand, use the other hand to break off the upper part of the ampoule in the direction away from the coloured point (see the pictures below).
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
