How many vials of dantrolene do I need to stock?
A new formulation of dantrolene, Ryanodex (Eagle Pharmaceuticals, USA), is formulated with 250 mg/vial; therefore, stocking three vials is recommended. Using a conservative weight estimation (100-kg individual), the initial dose of dantrolene is 13 vials (260 mg) of the older formulation and 1 vial of the newer formulation.
How much dantrolene should I take for an emergency?
FOR EMERGENCIES ONLY. To treat an MH episode, an initial dose of dantrolene at 2.5 mg/kg is recommended, with a suggested upper limit of 10 mg/kg. If a patient of average weight (approximately 70 kg) were to require dantrolene at the upper dosing limit, then at least 700 mg of dantrolene would be needed.
How is dantrolene administered in the treatment of hypermetabolism?
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 should I stock ryanodex® and dantrolene?
If Ryanodex® is stocked, MHAUS recommends having 3 vials available. Sterile water should be stocked alongside the dantrolene in the first drawer as it is necessary to reconstitute the powdered dantrolene. The amount stocked should reflect the formulation of dantrolene (larger volume is required for Dantrium®/Revonto® compared to Ryanodex®).
Why does dantrolene have 36 vials?
The full 36 vials of dantrolene is inexpensive insurance against patient injury or death and a malpractice claim, which the facility will lose. The full 36 vials of dantrolene should be available within five minutes of the diagnosis of MH.
How many vials of dantrolene are stocked?
For locations where MH trigger drugs are used on a regular basis, we recommend that 36 vials of dantrolene are immedi- ately available. The 36 vials will be enough to treat an MH crisis for 20e30 min in all adult patients.
How many vials of dantrolene are in malignant hyperthermia?
According to the European Malignant Hyperthermia Group guidelines for management of malignant hyperthermia, at least 36 vials of 20 mg dantrolene should be prepared within 10–15 minutes to effectively treat the condition.
How many vials of dantrolene are recommended to stock in your or if your facility uses general anesthesia?
If Dantrium®/Revonto® is stocked, MHAUS recommends having 36 vials available in each institution.
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 much dantrolene do you administer?
Adults—At first, 25 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 100 mg four times a day.
How is dantrolene supplied?
Dantrium Intravenous should be administered by continuous rapid intravenous push beginning at a minimum dose of 1 mg/kg, and continuing until symptoms subside or the maximum cumulative dose of 10 mg/kg has been reached. If the physiologic and metabolic abnormalities reappear, the regimen may be repeated.
How do you use dantrolene for malignant hyperthermia?
Malignant Hyperthermia Association of the United States (MHAUS) recommends continuing maintenance doses of dantrolene (1 mg/kg intravenous [IV] bolus every four to six hours or 0.25 mg/kg/hour IV continuous infusion) for at least 24 hours after the last observed sign of acute MH [60,74,83].
How do you mix dantrolene for malignant hyperthermia?
Each vial of Revonto (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.
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.
How fast should you administer 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.
How quickly does dantrolene work?
Myoglobinuria should be watched for and treated with fluids and diuretics if it occurs. The creatine kinase level will peak about 8-10 hours after the event and should be followed until it returns to near normal. A newer version of dantrolene dissolves in 15 seconds and thereby improves the rapidity of treatment.
How is dantrolene supplied?
Dantrium Intravenous should be administered by continuous rapid intravenous push beginning at a minimum dose of 1 mg/kg, and continuing until symptoms subside or the maximum cumulative dose of 10 mg/kg has been reached. If the physiologic and metabolic abnormalities reappear, the regimen may be repeated.
How do you store dantrolene?
Dantrolene should be kept in or very close to the operating room, so that it is available immediately if MH occurs. Dantrolene may be stored at room temperature.
How long is reconstituted dantrolene good for?
The reconstituted solution must be used within 6 hours but filtered immediately before use.
How long is dantrolene given?
Dantrolene therapy should be stopped if no observable benefit is derived after a total of 45 days of treatment. Doses should be given at the lowest possible effective dose for each patient. Use dantrolene with caution in patients with cardiac disease with severe cardiac function impairment.
How long does oral MH therapy last?
Duration of Therapy: 1 to 3 days. Comments: -Use for the prevention of MH should include avoiding agents that trigger MH. -Dose adjustment of oral therapy may be made within the recommended dosage range to avoid incapacitation (weakness, drowsiness, etc.) or excessive gastrointestinal irritation (nausea and/or vomiting).
Should elderly patients be cautious when selecting a medication?
Elderly: Dose selection should be cautious; use the lowest dose compatible with optimal response
How is dantrolene administered?
Dantrolene is available as an intravenous injection and an oral capsule. The choice of the method of administration is dependent on the intended use of the medication.Treatment of malignant hyperthermia: When symptoms of malignant hyperthermia present, 2.5 mg/kg dantrolene via intravenous push should be administered immediately. If the signs and symptoms of malignant hyperthermia persist, additional intravenous boluses of 1 to 2.5 mg/kg are indicated to a maximum cumulative dose of 10 mg/kg. Following the successful treatment of the initial reaction, 1 mg/kg of IV dantrolene should be provided every 6 hours for 24 hours since the last observed symptom of malignant hyperthermia to prevent a recurrence.[7] At any point during the treatment of malignant hyperthermia, contacting the Malignant Hyperthermia Association of the United States (MHAUS) at 1-800-MH-HYPER (1-800-644-9737) is appropriate for dantrolene dosing recommendations and ongoing treatment. [8]
How much mannitol is in dantrolene?
These vials also contain 3 gm of mannitol each. Given the known difficulty in mixing the solution, it is essential to call for additional help to assist with the medication preparation as the provider continues to monitor and provide resuscitative measures. A new formulation is supplied in 250 mg vials and only requires 5ml of sterile water for reconstitution. Because of the hyper-concentration of this form of dantrolene, blood concentrations rise to a much faster rate, presumably leading to more rapid onset and effect.
What is dantrolene sodium used for?
Among the many indications for the use of dantrolene, its primary indication, and FDA-approved usage in both children and adults, is for the treatment of malignant ...
How long before surgery can you give dantrolene?
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. Although this is an approved indication for the use of dantrolene, it is an unnecessary use if patients avoid triggering agents when they are susceptible to malignant hyperthermia.
Can dantrolene be discontinued?
For those taking the oral capsule for muscle spasticity, liver function tests require monitoring, and dantrolene should be discontinued if signs and symptoms of liver injury appear. These include elevated LFTs, jaundice, right upper quadrant pain, etc. These symptoms typically resolve upon the discontinuation of dantrolene. If dantrolene is to be reinstated, per recommendations, the patient should be inpatient, and the drug initiated in very small doses with gradual increases. [11]
Is dantrolene contraindicated for hyperthermia?
No contraindications exist to the use of IV dantrolene for the treatment of malignant hyperthermia. Oral dantrolene is contraindicated in patients with underlying liver disease, including cirrhosis, non-alcoholic steatohepatitis, and hepatitis B or C infections.
Does dantrolene cause hepatitis?
The intravenous administration of dantrolene in healthy volunteers has resulted in skeletal muscle weakness, dyspnea, respiratory muscle weakness, and decrease inspiratory capacity.[9] These are expected symptoms given the mechanism of action of the medication.Oral dantrolene carries a black box warning for the potential for hepatotoxicity, including overt hepatitis. Hepatic function should be evaluated before administering the oral capsule form and requires monitoring throughout the course of treatment. The medication should stop immediately if liver function becomes impaired. [10]
How many vials of dantrolene are in a 70 kg individual?
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. A new formulation of dantrolene, Ryanodex (Eagle Pharmaceuticals, USA), is formulated with 250 mg/vial; therefore, ...
Can dantrolene be delivered to maternity unit?
Another important aspect of the authors’ calculation is the assumption that dantrolene and the other supplies and drugs necessary to treat an MH crisis can be delivered to the maternity unit in a timely manner when needed in a crisis.