Details About Generic Salt ::  Dantrole

Main Medicine Class:: Skeletal muscle relaxant,direct acting   

(dan-troe-LEEN SO-dee-uhm)
Dantrium; Dantrium Intravenous
Class: Skeletal muscle relaxant/direct acting

 

Drugs Class ::

 Action Affects contraction of muscle at site beyond myoneural junction and directly on muscle itself; believed to interfere with calcium release from sarcoplasmic reticulum. Affects CNS, causing drowsiness, dizziness and generalized weakness.

Indications for Drugs ::

 Indications Control of spasticity associated with spinal cord injury, stroke, cerebral palsy or multiple sclerosis; prophylaxis, treatment and postcrisis therapy of malignant hyperthermia. Unlabeled use(s): Management of exercise-induced muscle pain, neuroleptic malignant syndrome, heat stroke.

Drug Dose ::

 Route/Dosage

Chronic Spasticity

ADULT: PO Initial dose: 25 mg q day; increase at 4 to 7 day intervals to 25 mg bid to qid, up to max of 100 mg bid to qid if necessary. CHILDREN: PO Initial dose: 0.5 mg/kg bid; increase to 0.5 mg/kg tid to qid, then by increments of 0.5 mg/kg, up to 3 mg/kg bid to qid, if necessary. Maximum 100 mg qid.

Malignant Hyperthermia

ADULTS & CHILDREN: PREOPERATIVE PROPHYLAXIS: PO 4 to 8 mg/kg/day in 3 or 4 divided doses for 1 or 2 days prior to surgery with last dose given 3 to 4 hrs before surgery or IV 2.5 mg/kg » 1¼ hrs before anesthesia. Infused over 1 hr. May repeat during surgery, if needed. Treatment: IV 1 mg/kg by continuous rapid push; evaluate and repeat as needed until cumulative total dose is £ 10 mg/kg. POSTCRISIS FOLLOW-UP: PO 4 to 8 mg/kg/day in 4 divided doses for 1 to 3 days to prevent recurrence. If IV route must be utilized, start with ³ 1 mg/kg, as needed.

Contraindication ::

 Contraindications Active hepatic disease; muscle spasm resulting from rheumatic disorders; where spasticity is used to sustain upright posture and balance in locomotion or to obtain or maintain increased function.

Drug Precautions ::

 Precautions

Pregnancy: Category C (parenteral). Lactation: Do not use in nursing women. Children: Safety in children < 5 yr not established. Special risk patients: Use drug with caution in patients with impaired pulmonary function (especially COPD) or cardiac function. Hepatic effects: Fatal and nonfatal liver disorders may occur; use drug with caution in patients with pre-existing hepatic impairment and in females and patients > 35 yr. Long-term use: Safety and efficacy not established; use only if significant pain or disability is present or nursing care is reduced. Consider carcinogenicity risk and liver damage with long-term use. Discontinue therapy if no benefit within 45 days. Malignant hyperthermia: Supportive care should be foremost in treatment (ie, concurrent with dantrolene therapy). Extravasation: Because of the high pH of the IV formulation, prevent extravasation into the surrounding tissue. IV Dantrolene: IV dantrolene is also associated with the loss of grip strength and weakness in the legs.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

Due to oral administration except where otherwise indicated.

CV: Tachycardia; erratic blood pressure; phlebitis. CNS: Drowsiness; dizziness; weakness; general malaise; fatigue; speech disturbances; seizures; headache; lightheadedness; insomnia, mental depression or confusion; increased nervousness. DERM: Abnormal hair growth; acne-like rash; pruritus; urticaria (IV); eczematoid eruption; sweating; erythema (IV). EENT Visual disturbance, diplopia, alteration of taste. GI: Diarrhea; constipation; bleeding; anorexia; dysphagia; gastric irritation; abdominal cramps. GU Increased urinary frequency; hematuria; crystalluria; difficult erection; urinary incontinence; nocturia; dysuria; urinary retention. HEPA Hepatitis. RESP: Pleural effusion with pericarditis; pulmonary edema (IV). OTHER: Myalgia; backache; chills; fever; feeling of suffocation; excessive tearing; thrombophlebitis (IV).

Drug Mode of Action ::  

 Action Affects contraction of muscle at site beyond myoneural junction and directly on muscle itself; believed to interfere with calcium release from sarcoplasmic reticulum. Affects CNS, causing drowsiness, dizziness and generalized weakness.

Drug Interactions ::

 Interactions

Clofibrate: Plasma protein binding of dantrolene reduced. Estrogens: Women receiving these may be at increased risk for hepatotoxicity. Verapamil: Hyperkalemia and myocardial depression possible. Warfarin: Plasma protein binding of dantrolene reduced.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess neuromuscular status before and during therapy.
  • Assess family’s anesthesia history. Ask specifically about crises or deaths in operating room.
  • Assess for constipation, and auscultate bowel sounds regularly.
  • Encourage patient to increase fluid and fiber intake during therapy.
  • Keep emergency equipment nearby to treat respiratory depression.
  • Measure and document intake and output.
  • Monitor infusion site regularly for potential complications.
  • If weakness or dizziness develops, keep side rails up and supervise ambulation.
  • If difficulty swallowing develops, implement safety precautions with meals and medications.

Drug Storage/Management ::

 Administration/Storage

  • Ensure good IV site using large peripheral vein; medication is very irritating to tissues.
  • Reconstitute powder for IV infusion in 60 ml of sterile water without bacteriostatic agent.
  • Shake until solution is clear.
  • Store at room temperature for up to 6 hr. Protect from direct light.

Drug Notes ::

 Patient/Family Education

  • Teach patient and family the name, action, administration and side effects of dantrolene.
  • Emphasize importance of follow-up exams and laboratory work to monitor drug therapy.
  • Instruct patient to report these symptoms to physician: weakness, malaise, fatigue, nausea, diarrhea, skin rash, itching, bloody or black tarry stools or yellowish discoloration of skin.
  • Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Caution patient that dantrolene may decrease grip strength and increase weakness of leg muscles especially when walking down stairs.
  • Advise patients to exercise caution in eating on day of administration because difficulty swallowing and choking is possible.

Disclaimer ::

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