DANTROLENE DRUGS Ryan Juniper August 21, 2019 CLASSMuscle relaxant PRESENTATIONOrange lyophilised powder. Formulations20mg dantrolene vial (with 3g mannitol)250mg dantrolene vial INDICATIONS & DOSINGMalignant hyperthermiaAdult; 200mg (10x 20mg vials) or 250mg (1x 250mg vial) IV bolusPaediatric; 2.5mg/kg IV bolusRepeat dose every 10-15 minutes until clinical resolutionMaximum dose 10mg/kg unless manifestations of syndrome reappear PRACTICALITIESAdministrationReconstitute 20mg dantrolene vial with 60ml of waterReconstitute 250mg dantrolene vial with 5ml of water IncompatibilitiesSodium chloride5% dextrosePrecipitates in some glass containers, mix in vials provided Practice tipsEnsure intravenous line is patent, avoid extravasation due to high pH PHARMACOKINETICSOnsetIV; minutes Duration of action3-5 hours MetabolismMajority hepatic metabolism to inactive metabolites, specific metabolic pathways unknown Elimination15-25% renal excretion, specific elimination pathways unknown MECHANISMInhibition of ryanodine receptors in the sarcoplasmic reticulum of skeletal muscle reduces muscle contraction DESIRED CLINICAL EFFECTSMusculoskeletalSkeletal muscle relaxationTermination of malignant hyperthermic crisis CardiovascularImproves beta-adrenergic receptor responsiveness OTHER CLINICAL EFFECTS, ADVERSE EFFECTS & TOXICITIESRespiratoryRespiratory failure in those with respiratory depression or compromise, secondary to muscle weakness RenalVolume depletion secondary to mannitol load NeurologicalSedation GastrointestinalDysphagiaFatal and non-fatal hepatic dysfunction OtherExtravasation, alkaline tissue necrosis CONSIDERATIONSPrecautionsHepatic diseaseWhere spasticity is required to maintain posture or respiratory function Obstetric ADEC category B2 Drug interactionsCo-administration with calcium-channel blockers (specifically verapamil) may lead to fatal hyperkalaemiaPotentiates the effects of drugs with respiratory depressant actionPotentiates the effects of CNS depressantsPotentiates the effect of neuromuscular blockers REFERENCESDrug information has been compiled from multiple sources includingDrugs in Anaesthesia and Intensive Care (Scarth & Smith)Micromedex (IBM)BJA Education (Oxford Academic)Pharmacology for Anaesthesia and Intensive Care (Cambridge)Australian Prescriber (NPS MedicineWise) Tags: WIKI Leave a Reply Cancel reply Save my name, email, and website in this browser for the next time I comment.