Usual Adult Dose for Anesthesia

The dosing information provided here is manufacturer suggested and is intended to serve as a guide only:

INITIAL DOSE: 0.08 to 0.1 mg/kg by IV bolus

• This dose is expected to produce good or excellent nonemergency intubation in 2.5 to 3 minutes.
• Neuromuscular blockade lasts 25 to 30 minutes, with recovery to 25% of control at 25 to 40 minutes after injection and recovery to 95% of control at 45 to 65 minutes after injection.
• In the presence of potent inhalation anesthetics, the neuromuscular blocking effect is enhanced.
• If this drug is first administered more than 5 minutes after the start of inhalation agent or when steady-state has been achieved, the initial dose of this drug may be reduced by approximately 15% (i.e., 0.06 to 0.085 mg/kg).
• Prior administration of succinylcholine may enhance the neuromuscular blocking effect and duration of action. If intubation is performed using succinylcholine, a reduction of initial dose of this drug to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia may be required.

MAINTENANCE DOSE DURING PROLONGED SURGICAL PROCEDURES: 0.01 to 0.015 mg/kg 25 to 40 minutes later, then as frequently as every 12 to 15 minutes.

CONTINUOUS INFUSION: Initiate with an intubating dose of 80 to 100 mcg/kg followed 20 to 40 minutes later with 1 mcg/kg/minute.

• Infuse this drug only after early evidence of spontaneous recovery from the bolus dose.
• Long-term IV infusion to support mechanical ventilation in the intensive care unit has not been studied sufficiently to support dose recommendations.
• Adjust the rate of administration according to twitch response.
• An initial rate of 1 mcg/kg/min is recommended, with the rate of the infusion adjusted thereafter to maintain a 90% suppression of twitch response. Average infusion rates may range from 0.8 to 1.2 mcg/kg/min.

Comments:

• Dosing provided here is manufacturer suggested; consult local protocol.
• Since this drug lacks cumulative effects, subsequent maintenance doses, if required, may be administered at relatively regular intervals, ranging from 12 to 15 minutes under balanced anesthesia, slightly longer under inhalation agents. (If less frequent administration is desired, higher maintenance doses may be administered.)
• Inhalation anesthetics, particularly enflurane and isoflurane may enhance the neuromuscular blocking action of nondepolarizing muscle relaxants. In the presence of steady-state concentrations of enflurane or isoflurane, it may be necessary to reduce the rate of infusion 25 to 60 percent 45 to 60 min after the intubating dose. Under halothane anesthesia it may not be necessary to reduce the rate of infusion.

Use: As an adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation

Usual Pediatric Dose for Anesthesia

The dosing information provided here is manufacturer suggested and is intended to serve as a guide only:

10 to 16 years:
Use adult dosing.

1 to 10 years: May require a slightly higher initial dose than adults and may also require supplementation slightly more often than adults.

Infants under 1 year of age but older than 7 weeks: Are moderately more sensitive to this drug on a mg/kg basis than adults and take about 1.5 times as long to recover.

Use: As an adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.

Precautions

US BOXED WARNINGS:

• This drug should be administered by adequately trained individuals familiar with its actions, characteristics, and hazards.

CONTRAINDICATIONS:

• Hypersensitivity to the active component or any of the ingredients

Safety and efficacy have not been established in patients younger than 7 weeks.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• This drug is for IV use only.
• This drug should be administered by or under the supervision of experienced clinicians familiar with the use of neuromuscular blocking agents.
• The dose should be individualized in each case.
• To minimize the possibility of overdose, the monitoring of muscle twitch response to peripheral nerve stimulation is advised.

Storage requirements:

• Store dry powder at 20C to 25C (68F to 77F).
• Protect from light.
• Retain in carton until time of use.

Reconstitution/preparation techniques:

• Prepare this drug by adding an appropriate infusion solution such as Dextrose 5% Injection, Sodium Chloride 0.9% Injection, Dextrose 5% and Sodium Chloride 0.9% Injection, or Lactated Ringer's Injection.
• Unused portions of infusion solutions should be discarded.
• The manufacturer product information should be consulted for further preparation instructions.

IV compatibility:

• Sodium Chloride 0.9% Injection
• Dextrose 5% Injection
• Sterile Water for Injection
• Dextrose 5% in Sodium Chloride 0.9% Injection
• Lactated Ringer's Injection

General:

• Single dose use: When reconstituted with IV solutions not containing an antimicrobial preservative (e.g., sterile water for injection) refrigerate and use within 24 hours. Discard unused portion.
• Multi dose use: When reconstituted with bacteriostatic water for injection, use within 5 days. The reconstituted solution may be stored at room temperature or refrigerated.