Dantrolene Sodium(dan’ troe leen)
Dantrium, Dantrium Intravenous
PREGNANCY CATEGORY C
Drug Classes
Skeletal muscle relaxant (direct acting)
Therapeutic Actions
Relaxes skeletal muscle within the skeletal muscle fiber, probably by interfering with the release of calcium from the sarcoplasmic reticulum; does not interfere with neuromuscular transmission or affect the surface membrane of skeletal muscle.
Indications
Oral: Control of clinical spasticity resulting from upper motor neuron disorders, such as spinal cord injury, stroke, cerebral palsy, or MS; not indicated for relief of skeletal muscle spasm resulting from rheumatic disorders; continued long-term administration is justified if use significantly reduces painful or disabling spasticity (clonus);
significantly reduces the intensity or degree of nursing care required; rids the patient of problematic manifestation of spasticity
Oral: Preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible patients who must undergo surgery or anesthesia; after a malignant hyperthermia crisis to prevent recurrence
Parenteral (IV): Management of the fulminant hypermetabolism of skeletal muscle characteristic of malignant hyperthermia crisis; preoperative prevention of malignant hyperthermia
Unlabeled uses: Exercise-induced muscle pain, neuroleptic malignant syndrome
Contraindications and Cautions
Contraindicated with active hepatic disease; spasticity used to sustain upright posture, balance in locomotion or to gain or retain increased function; lactation.
Use cautiously with female patients and patients older than 35 yr (increased risk for potentially fatal, hepatocellular disease); impaired pulmonary function; severely impaired cardiac function due to myocardial disease; history of previous liver disease or impairment.
Malignant hyperthermia is a medical emergency that would override contraindications and cautions.
Available Forms
Capsules—25, 50, 100 mg; powder for injection—20 mg/vial
Dosages
Adults
Oral
Chronic spasticity: Titrate and individualize dosage; establish a therapeutic goal before therapy, and increase dosage until maximum performance compatible with the dysfunction is achieved. Initially, 25 mg daily for 7 days. Increase to 25 mg tid for 7 days; then increase to 50 mg tid and to 100 mg tid if necessary. Most patients will respond to 400 mg/day or less; maintain each dosage level for 7 days to evaluate response. Discontinue drug after 45 days if benefits are not evident.
Preoperative prophylaxis of malignant hyperthermia: 4–8 mg/kg/day PO in three to four divided doses for 1–2 days prior to surgery; give last dose about 3–4 hr before scheduled surgery with a minimum of water. Adjust dosage to the recommended range to prevent incapacitation due to drowsiness and excessive GI irritation.
Postcrisis follow-up: 4–8 mg/kg/day PO in four divided doses for 1–3 days to prevent recurrence.
Parenteral
Treatment of malignant hyperthermia: Discontinue all anesthetics as soon as problem is recognized. Give dantrolene by continuous rapid IV push beginning at a minimum dose of 1 mg/kg and continuing until symptoms subside or a maximum cumulative dose of 10 mg/kg has been given. If physiologic and metabolic abnormalities reappear, repeat regimen. Give continuously until symptoms subside.
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