Precautions
Preoperatively: Administer 4 mg/kg/day to 8 mg/kg/day of oral Dantrolene sodium caspules in 3 or 4 divided doses for one or two days prior to surgery, with the last dose being given approximately 3 to 4 hours before scheduled surgery with a minimum of water.
How do you administer Dantrolene sodium caspules?
Each vial is reconstituted with 60cc of sterile water for injection. The dantrolene bolus must be given within 10 minutes of the diagnosis of MH, and may be repeated every 5 minutes until the hypermetabolism stops or the maximum dose of 10mg/kg is given. Treatment should continue for 48 hours after the episode at 1mg/kg every 4 hours.
How is dantrolene administered in the treatment of hypermetabolism?
Take dantrolene exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of dantrolene for spasticity and gradually increase your dose, not more than once every 7 days.
How should I take dantrolene for spasticity?
Dantrolene comes as a capsule to take by mouth. When used to treat spasticity, it is usually taken once a day for 7 days and then increased gradually every 7 days to three to four times a day. When used to prevent malignant hyperthermia, it is usually given three to four times a day, starting 1 or 2 days before surgery.
How often should I take dantrolene?
How do you give dantrolene in malignant hyperthermia?
Prophylaxis of malignant hyperthermia: 2.5 mg/kg intravenously over one minute, approximately 75 minutes before surgery. Repeat doses can be given during anesthesia and surgery in prolonged cases.
How fast do you administer dantrolene?
Malignant hyperthermia treatment: Administer by IV push. Malignant hyperthermia prophylaxis: Administer IV over at least 1 minute.
How do you take dantrolene?
Dantrolene may be taken with or without food or on a full or empty stomach. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed. Take this medicine only as directed by your doctor. Do not take more of it and do not take it more often than your doctor ordered.
How do you give MH dantrolene?
Dosage for prevention of malignant hyperthermia The recommended prophylactic dose of RYANODEX® is 2.5 mg/kg administered intravenously over a period of at least 1 minute, starting approximately 75 minutes prior to surgery. Avoid agents that trigger MH.
What is the main side effect of dantrolene?
Drowsiness, dizziness, weakness, tiredness, nausea, and diarrhea may occur as your body adjusts to this medication and usually lessen after several days. Headache, constipation, trouble speaking, and drooling may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
What do you mix dantrolene with?
Each vial of dantrolene sodium for injection should be reconstituted by adding 60 mL of sterile water for injection USP (without a bacteriostatic agent), and the vial shaken for approximately 20 seconds or until the solution is clear.
How do you dissolve dantrolene?
Each vial of Dantrium must be reconstituted by adding 60 ml of sterile water and shaken until the solution is clear. As dantrolene is poorly soluble in water, some time is required to reconstitute the 10 or more vials of dantrolene needed for the initial therapy4,8.
Can dantrolene be mixed with normal saline?
An article about preparing for a malignant hyperthermia incident that appeared in October's Manager's Guide to Staff and Patient Safety stated that the rescue drug dantrolene should be mixed with saline solution.
What is the black box warning for dantrolene?
The therapy also includes a black box warning on the prescription drug label to call attention to serious or life-threatening risks. Dantrium may cause serious liver toxicity and symptomatic hepatitis (fatal or nonfatal) with different dosages.
What is the first treatment for malignant hyperthermia?
Immediate treatment of malignant hyperthermia includes: Medication. A drug called dantrolene (Dantrium, Revonto, Ryanodex) is used to treat the reaction by stopping the release of calcium into muscles.
Why is dantrolene mixed with mannitol?
Today, dantrolene is available for intravenous use in vials containing 20 mg lyophilized dantrolene sodium added to 3 g mannitol to improve water solubility.
What are three signs of malignant hyperthermia?
Severe muscle rigidity or spasms. Rapid, shallow breathing and problems with low oxygen and high carbon dioxide. Rapid heart rate. Irregular heart rhythm.
How many vials of dantrolene 20 mg per vial formulation should be stocked at all times on the MH cart?
The Malignant Hyperthermia Association of the United States recommends stocking 36 vials (each vial contains 20 mg; therefore, 36 vials is approximately 10 mg/kg for a 70-kg individual) in the MH cart.
How do you manage malignant hyperthermia?
Immediate treatment of malignant hyperthermia includes:Medication. A drug called dantrolene (Dantrium, Revonto, Ryanodex) is used to treat the reaction by stopping the release of calcium into muscles. ... Oxygen. You may have oxygen through a face mask. ... Body cooling. ... Extra fluids. ... Supportive care.
Can you overdose on dantrolene?
Overdoses of DNP are often fatal and there is no specific reversal therapy. Dantrolene interferes with calcium release in skeletal muscle and is traditionally used to treat malignant hyperthermia.
How much dantrolene do you give a horse?
Prevention of postanesthetic myositis (PAM); (extra-label): To prevent muscle damage in horses undergoing hypotensive anesthesia: 6 mg/kg enterally (in 2 L of water given via NG tube) 60 to 90 minutes prior to general anesthesia.
Dantrolene Description
The chemical formula of Dantrolene sodium is hydrated 1- [ [ [5- (4-nitrophenyl)-2-furanyl]methylene] amino]-2, 4-imidazolidinedione sodium salt. It is an orange powder, slightly soluble in water, but due to its slightly acidic nature the solubility increases somewhat in alkaline solution. The anhydrous salt has a molecular weight of 336.
Dantrolene - Clinical Pharmacology
In isolated nerve-muscle preparation, Dantrolene sodium has been shown to produce relaxation by affecting the contractile response of the skeletal muscle at a site beyond the myoneural junction, directly on the muscle itself.
Indications and Usage for Dantrolene
Dantrolene sodium capsules are indicated in controlling the manifestations of clinical spasticity resulting from upper motor neuron disorders (e.g., spinal cord injury, stroke, cerebral palsy, or multiple sclerosis). It is of particular benefit to the patient whose functional rehabilitation has been retarded by the sequelae of spasticity.
Contraindications
Active hepatic disease, such as hepatitis and cirrhosis, is a contraindication for use of Dantrolene sodium capsules. Dantrolene sodium capsules are contraindicated where spasticity is utilized to sustain upright posture and balance in locomotion or whenever spasticity is utilized to obtain or maintain increased function.
Warnings
It is important to recognize that fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with Dantrolene sodium therapy.
Precautions
Dantrolene sodium should be used with caution in patients with impaired pulmonary function, particularly those with obstructive pulmonary disease, and in patients with severely impaired cardiac function due to myocardial disease. Dantrolene sodium is associated with pleural effusion with associated eosinophilia.
Adverse Reactions
The most frequently occurring side effects of Dantrolene sodium have been drowsiness, dizziness, weakness, general malaise, fatigue, and diarrhea. These are generally transient, occurring early in treatment, and can often be obviated by beginning with a low dose and increasing dosage gradually until an optimal regimen is established.
Topic
Following treatment of acute MH, how much dantrolene should be administered and for how long? What criteria should be used to determine stopping treatment with dantrolene?
Recommendations
After initial bolus dosing to treat the acute MH crisis, maintenance dantrolene should be continued 1 mg/kg/dose every 4-6 hours while monitoring the patient for signs of recrudescence.
Supporting Evidence
Background: Following initial successful treatment of acute MH, MHAUS currently recommends continuing dantrolene therapy for at least 24 hours and sometimes longer as clinically indicated.
What is dantrolene?
Dantrolene is a muscle relaxer that is used to treat muscle spasticity (stiffness and spasms) caused by conditions such as a spinal cord injury, stroke, cerebral palsy, or multiple sclerosis.
Warnings
You should not take dantrolene if you have active liver disease. Do not take dantrolene at a time when you need muscle tone for safe balance and movement during certain activities.
Before taking this medicine
You should not use dantrolene if you are allergic to it, or if you have:
How should I take dantrolene?
Your doctor will perform blood tests to make sure you do not have conditions that would prevent you from safely using dantrolene.
What happens if I miss a dose?
Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking dantrolene?
Avoid driving or hazardous activity until you know how dantrolene will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.
Required supportive measures
In addition to treatment with RYANODEX®, institute the following supportive measures:
Dosage in the event of MH relapse 7
If the physiologic and metabolic abnormalities reappear, repeat RYANODEX® dosing by intravenous push starting with 1 mg/kg.*
Dosage for prevention of malignant hyperthermia 7
The recommended prophylactic dose of RYANODEX® is 2.5 mg/kg administered intravenously over a period of at least 1 minute, starting approximately 75 minutes prior to surgery. Avoid agents that trigger MH.
Dosage for pediatric patients 7
The recommended weight-based dose of RYANODEX® for pediatric patients in the treatment and prevention of MH is the same as for adults for these indications. 7
Dantrolene Description
This medication is used to treat muscle tightness and cramping (spasms) caused by certain nerve disorders such as spinal cord injury, stroke, cerebral palsy, and multiple sclerosis.
May Treat: Malignant hyperthermia · Malignant hyperthermia · Muscle spasm · Muscle spasticity of cerebral origin · Muscle spasticity of spinal origin
Brand Names: Dantrium · Revonto · Ryanodex
Drug Class: Skeletal Muscle Relaxant - Direct Muscle Relaxants
Availability: Prescription Required
Pregnancy: Consult a doctor before using
May Treat: Malignant hyperthermia · Malignant hyperthermia · Muscle spasm · Muscle spasticity of cerebral origin · Muscle spasticity of spinal origin
Brand Names: Dantrium · Revonto · Ryanodex
Drug Class: Skeletal Muscle Relaxant - Direct Muscle Relaxants
Availability: Prescription Required
Pregnancy: Consult a doctor before using
Lactation: Consult a doctor before using
Driving: May cause drowsiness or dizziness. Use caution
- Call MD for nausea, pain, fatigue, and dark urine.
- Call doctor if you are not better in 45 days.
- Not recommended when breast feeding
- Call MD for nausea, pain, fatigue, and dark urine.
- Call doctor if you are not better in 45 days.
- Not recommended when breast feeding
- May make you drowsy or dizzy. Drive with caution
- Lab tests may be ordered to monitor therapy
- Tell Dr/dentist on drug prior to any surgery.
- Review all drugs you are taking with your doctor
- Skin may be more prone to sunburn
- Use sunscreen
Dantrolene - Clinical Pharmacology
Indications and Usage For Dantrolene
Contraindications
Warnings
Precautions
- Dantrolene may be taken with or without food or on a full or empty stomach. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed. Take this medicine only as directed by your doctor. Do not take more of it and do not take it more often than your doctor ordered.
Adverse Reactions
Overdosage
Dantrolene Dosage and Administration
How Is Dantrolene Supplied