1 vial

$133

1 tablet 25mg

65 cents

  • Malignant hyperthermia (IV therapy only)

  • Control of chronic spasticity (PO therapy)

IV:
Reconstitute each 20mg vial with 60ml of Water for Injection and shake vigorously until solution is clear (concentration is 0.333mg/ml). A large bore, vented needle (as found in the malignant hyperthermia box in theatre) will hasten the transfer of diluent and reconstituted solution. Inspect carefully for cloudiness or precipitation before administration. Compatible only with Water from Injection. Do not mix with other fluid or drugs. Reconstituted solution should be stored at room temperature and must be protected from direct light. Use solution within 6 hours of reconstitution.

PO:
Dantrolene 25mg and 50mg capsules (orange / tan)


ADULT DOSE
IV:
Administer solution by continuous IV push beginning at 1mg/kg and continuing until response is achieved or a maximum cumulative dose of 10mg/kg is reached. May repeat if required.

PO:
Oral therapy is not appropriate for treatment of malignant hyperthermia. The usual dose for chronic spasticity is between 25mg daily and 50mg four times a day.

PAEDIATRIC DOSE
IV:
Administer solution by continuous IV push beginning at 1mg/kg and continuing until response is achieved or a maximum cumulative dose of 10mg/kg is reached. May repeat if required.

PO:
For spasticity: 0.5mg/kg-3mg/kg 6 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function

In skeletal muscle, dantrolene dissociates the excitation-contraction coupling, probably by interfering with the release of Ca++ from the sarcoplasmic reticulum. It is hypothesized that addition of dantrolene to the "triggered" malignant hyperthermic muscle cell reestablishes a normal level of ionized calcium in the myoplasm. Inhibition of calcium release from the sarcoplasmic reticulum by dantrolene re-establishes the myoplasmic calcium equilibrium, increasing the percentage of bound calcium.

CONTRAINDICATIONS:
None.

WARNINGS
The use of dantrolene IV in the management of malignant hyperthermia crisis is not a substitute for previously known supportive measures. These measures must be individualized, but it will usually be necessary to discontinue the suspect triggering agents, attend to increased oxygen requirements, manage the metabolic acidosis, institute cooling when necessary, monitor urinary output, and monitor for electrolyte imbalance.

PRECAUTIONS
General
Care must be taken to prevent extravasation of dantrolene solution into the surrounding tissues due to the high pH of the intravenous formulation.
Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with dantrolene therapy.

Laboratory Tests:
No tests in addition to routine ICU test are indicated

Drug/Laboratory Test Interactions:
None of note

IMPORTANT DRUG INTERACTIONS FOR THE ICU
The combination of therapeutic doses of IV dantrolene sodium and verapamil in anaesthetised pigs has resulted in ventricular fibrillation and cardiovascular collapse in association with marked hyperkalaemia. It is recommended that the combination of IV dantrolene sodium and calcium channel blockers, such as verapamil, not be used together during the management of malignant hyperthermia crisis until the relevance of these findings to humans is established.
Administration of dantrolene may potentiate vecuronium-induced neuromuscular block.

Body as a whole:

Erythematous rash, anaphylaxis
Central nervous system:
Weakness
Cardiovascular system:
Pulmonary oedema

None of the serious reactions occasionally reported with long-term oral dantrolene use, such as hepatitis, seizures, and pleural effusion with pericarditis, have been reasonably associated with short-term dantrolene IV therapy.
The following events have been reported in patients receiving oral dantrolene:
Hepatitis, seizures, pericarditis, aplastic anaemia, leukopaenia, lymphocytic lymphoma, and heart failure.

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