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NIMBEX FORTE 5MG/ML SOLUTION FOR INJECTION/INFUSION

Active substance: CISATRACURIUM BESILATE

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.
. .

10000000083778

Information for the Physician

Dosage in paediatric patients
Tracheal Intubation (paediatric patients aged 1 month to 12 years): As in
adults, the recommended intubation dose of Nimbex is 0.15 mg/kg (body
weight) administered rapidly over 5 to 10 seconds.
This dose produces good to excellent conditions for tracheal intubation 120
seconds following injection of Nimbex. Pharmacodynamic data for this dose
are presented in the tables below.
Nimbex has not been studied for intubation in ASA Class III-IV paediatric
patients. There are limited data on the use of Nimbex in paediatric patients
under 2 years of age undergoing prolonged or major surgery.

Please refer to the Summary of Product Characteristics (SPC) for
further details on this product.

Trade Name of the Medicinal Product
Nimbex 2 mg/ml solution for injection/infusion
Nimbex Forte 5 mg/ml solution for injection/infusion

Paediatric Patients aged 1 to 11 months
Nimbex Dose
mg/kg
(body weight)

Nimbex 2 mg/ml, solution for injection:
Cisatracurium 2 mg as cisatracurium besilate 2.68 mg per 1 ml
one ampoule of 10 ml contains 20 mg of cisatracurium
one ampoule of 25 ml contains 50 mg of cisatracurium
Nimbex Forte 5 mg/ml, solution for injection:
Cisatracurium 5 mg as cisatracurium besilate 6.70 mg per 1 ml
one vial of 30 ml contains 150 mg of cisatracurium

Nimbex Dose
mg/kg
(body weight)

Solution for injection/infusion.
Colourless to pale yellow or greenish yellow solution. Practically free from
visible particulate matter.

Therapeutic Indications
Nimbex is indicated for use during surgical and other procedures and in
intensive care in adults and children aged 1 month and over. Nimbex can be
used as an adjunct to general anaesthesia, or sedation in the Intensive Care
Unit (ICU) to relax skeletal muscles, and to facilitate tracheal intubation and
mechanical ventilation.

Posology and Method of Administration
Nimbex should be only administered by or under the supervision of
anaesthetists or other clinicians who are familiar with the use and action
of neuromuscular blocking agents. Facilities for tracheal intubation, and
maintenance of pulmonary ventilation and adequate arterial oxygenation
have to be available.
Please note that Nimbex should not be mixed in the same syringe or
administered simultaneously through the same needle as propofol injectable
emulsion or with alkaline solutions such as sodium thiopentone.
Nimbex contains no antimicrobial preservative and is intended for single
patient use.
Monitoring advice
As with other neuromuscular blocking agents, monitoring of neuromuscular
function is recommended during the use of Nimbex in order to individualise
dosage requirements.
Use by intravenous bolus injection
Dosage in adults
Tracheal Intubation. The recommended intubation dose of Nimbex for
adults is 0.15 mg/kg (body weight). This dose produced good to excellent
conditions for tracheal intubation 120 seconds after administration of
Nimbex, following induction of anaesthesia with propofol.
Higher doses will shorten the time to onset of neuromuscular block.
The following table summarises mean pharmacodynamic data when Nimbex
was administered at doses of 0.1 to 0.4 mg/kg (body weight) to healthy adult
patients during opioid (thiopentone/fentanyl/midazolam) or propofol anaesthesia.
Time to 90%
T1*
Suppression
(min)

0.1
0.15
0.2
0.4

Opioid
Propofol
Opioid
Opioid

3.4
2.6
2.4
1.5

Time to
Maximum
T1*
Suppression
(min)
4.8
3.5
2.9
1.9

Time to 25%
Spontaneous
T1*Recovery
(min)
45
55
65
91

* T1 Single twitch response as well as the first component of the
Train-of-four response of the adductor pollicis muscle following
supramaximal electrical stimulation of the ulnar nerve.
Enflurane or isoflurane anaesthesia may extend the clinically effective
duration of an initial dose of Nimbex by as much as 15%.
Maintenance. Neuromuscular block can be extended with maintenance
doses of Nimbex. A dose of 0.03 mg/kg (body weight) provides
approximately 20 minutes of additional clinically effective neuromuscular
block during opioid or propofol anaesthesia.
Consecutive maintenance doses do not result in progressive prolongation of effect.
Spontaneous Recovery. Once spontaneous recovery from neuromuscular
block is underway, the rate is independent of the Nimbex dose administered.
During opioid or propofol anaesthesia, the median times from 25 to 75% and
from 5 to 95% recovery are approximately 13 and 30 minutes, respectively.
Reversal. Neuromuscular block following Nimbex administration is readily
reversible with standard doses of anticholinesterase agents. The mean times
from 25 to 75% recovery and to full clinical recovery (T4:T1 ratio ≥ 0.7) are
approximately 4 and 9 minutes respectively, following administration of the
reversal agent at an average of 10% T1 recovery.

Package Leaflet: Information for the User

Halothane
Opioid

Anaesthetic
Background

Time to 90%
Suppression
(min)

0.15
0.15

Halothane
Opioid

2.3
2.6

Read all of this leaflet carefully before
you are given this medicine.
• eep this leaflet. You may need to read it
K
again.
• f you have any further questions, ask your
I
doctor.
• f any of the side effects get serious, or if
I
you notice any side effects not listed in this
leaflet, please tell your doctor.

Nimbex Dose
mg/kg
(body weight)

Anaesthetic
Background

Time to 90%
Suppression
(min)

0.08
0.1

Halothane
Opioid

1.7
1.7

Halothane may be expected to extend the clinically effective duration of
a dose of Nimbex by up to 20%. No information is available on the use of
Nimbex in children during anaesthesia with other halogenated fluorocarbon
anaesthetic agents, but these agents may also be expected to extend the
clinically effective duration of a dose of Nimbex.
Maintenance (paediatric patients aged 2-12 years). Neuromuscular
block can be extended with maintenance doses of Nimbex. In paediatric
patients aged 2 to 12 years, a dose of 0.02 mg/kg (body weight) provides
approximately 9 minutes of additional clinically effective neuromuscular
block during halothane anaesthesia. Consecutive maintenance doses do not
result in progressive prolongation of effect.
There are insufficient data to make a specific recommendation for maintenance
dosing in paediatric patients under 2 years of age. However, very limited data
from clinical studies in paediatric patients under 2 years of age suggest that a
maintenance dose of 0.03 mg/kg may extend clinically effective neuromuscular
block for a period of up to 25 minutes during opioid anaesthesia.
Spontaneous Recovery. Once recovery from neuromuscular block is
underway, the rate is independent of the Nimbex dose administered. During
opioid or halothane anaesthesia, the median times from 25 to 75% and
from 5 to 95% recovery are approximately 11 and 28 minutes, respectively.
Reversal. Neuromuscular block following Nimbex administration is readily
reversible with standard doses of anti-cholinesterase agents. The mean times
from 25 to 75% recovery and to full clinical recovery (T4:T1 ratio ≥ 0.7) are
approximately 2 and 5 minutes respectively, following administration of the
reversal agent at an average of 13% T1 recovery.
Use by intravenous infusion
Dosage in adults and children aged 2 to 12 years
Maintenance of neuromuscular block may be achieved by infusion of Nimbex.
An initial infusion rate of 3 µg/kg (body weight)/min (0.18 mg/kg/hr) is
recommended to restore 89 to 99% T1 suppression following evidence of
spontaneous recovery. After an initial period of stabilisation of neuromuscular
block, a rate of 1 to 2 µg/kg (body weight)/min (0.06 to 0.12 mg/kg/hr) should
be adequate to maintain block in this range in most patients.
Reduction of the infusion rate by up to 40% may be required when Nimbex
is administered during isoflurane or enflurane anaesthesia.
The infusion rate will depend upon the concentration of cisatracurium in
the infusion solution, the desired degree of neuromuscular block, and the
patient’s weight. The following table provides guidelines for delivery of
undiluted Nimbex.
Infusion Delivery Rate of Nimbex injection 2 mg/ml
Patient
(body weight)
(kg)
20
70
100

Dose (µg/kg/min)
1.0
0.6
2.1
3.0

In this leaflet:
1 What Nimbex is and what it is used for
2 Before you are given Nimbex
3 How Nimbex is given
4 Possible side effects
5 How to store Nimbex
6 Further information

1 What Nimbex is and what it is used for
Nimbex contains a medicine called cisatracurium.
This belongs to a group of medicines called
muscle relaxants.
Nimbex is used:
• o relax muscles during operations on adults
t
and children over 1 month of age, including
heart surgery




1.5
0.9
3.2
4.5

2.0
1.2
4.2
6.0

Infusion Rate
3.0
1.8
6.3
9.0

mL/hr
mL/hr
mL/hr

Steady rate continuous infusion of Nimbex is not associated with a
progressive increase or decrease in neuromuscular blocking effect.

Do not use Nimbex if:
• ou are allergic (hypersensitive) to
y
cisatracurium, any other muscle relaxant or
any of the other ingredients in Nimbex (listed
in Section 6)
• ou have reacted badly to an anaesthetic
y
before.
Do not have Nimbex if any of the above apply to
you. If you are not sure, talk to your doctor, nurse
or pharmacist before you have Nimbex.



Time to
Time to 25%
Maximum Spontaneous
Suppression T1 Recovery
(min)
(min)
2.5
31
2.8
28

Administration of Nimbex following suxamethonium has not been studied
in paediatric patients.

• o help insert a tube into the windpipe (tracheal
t
intubation), if a person needs help to breathe
• o relax the muscles of adults in intensive care.
t
Ask your doctor if you would like more
explanation about this medicine.



Time to
Time to 25%
Maximum Spontaneous
Suppression T1 Recovery
(min)
(min)
3.0
43
3.6
38

When Nimbex is not required for intubation: A dose of less than 0.15 mg/kg
can be used. Pharmacodynamic data for doses of 0.08 and 0.1 mg/kg for
paediatric patients aged 2 to 12 years are presented in the table below:

2 Before you are given Nimbex

Nimbex 2 mg/ml solution for
injection/infusion
Nimbex Forte 5 mg/ml solution for
injection/infusion

Time to 90%
Time to
Time to 25%
Suppression Maximum Spontaneous
(min)
Suppression T1 Recovery
(min)
(min)
1.4
2.0
52
1.4
1.9
47

Paediatric Patients aged 1 to 12 years

Pharmaceutical Form

Anaesthetic
Background

Anaesthetic
Background

0.15
0.15

Qualitative and Quantitative Composition

Initial Nimbex
Dose mg/kg
(body weight)

In paediatric patients aged 1 month to 12 years, Nimbex has a shorter
clinically effective duration and a faster spontaneous recovery profile
than those observed in adults under similar anaesthetic conditions. Small
differences in the pharmacodynamic profile were observed between the age
ranges 1 to 11 months and 1 to 12 years which are summarised in the tables
below.

Take special care with Nimbex
Check with your doctor, nurse or pharmacist
before having this medicine if:
• ou have muscle weakness, tiredness or
y
difficulty in co-ordinating your movements
(myasthenia gravis)
• ou have a neuromuscular disease, such as
y
a muscle wasting disease, paralysis, motor
neurone disease or cerebral palsy
• ou have a burn which requires medical
y
treatment.
• ou have ever had an allergic reaction to any
y
muscle relaxant which was given as part of an
operation

If you are not sure if any of the above apply to
you, talk to your doctor, nurse or pharmacist
before you are given Nimbex.
Taking other medicines
Please tell your doctor if you are taking or have
recently taken any other medicines, including
medicines obtained without a prescription.














In particular tell your doctor if you are taking any
of the following:
• naesthetics (used to reduce sensation and
a
pain during surgical procedures)
• ntibiotics (used to treat infections)
a
• edicines for uneven heart beats
m
(anti-arrhythmics)
• edicines for high blood pressure
m
• ater tablets (diuretics), such as furusemide
w
• edicines for inflammation of the joints, such
m
as chloroquine or d-penicillamine
• teroids
s
• edicines for fits (epilepsy), such as phenytoin
m
or carbamazepine
• edicines for mental illness, such as lithium,
m
monoamine oxidase inhibitors (MAOIs) or
chlorpromazine (which can also be used for
sickness)
• edicines containing magnesium
m
• rugs for Alzheimer’s disease
d
(anticholinesterases e.g. donepezil).
Pregnancy and breast-feeding
Ask your doctor for advice before taking any
medicine.
Driving and using machines
If you are only staying in hospital for the day,
your doctor will tell you how long to wait before
leaving the hospital or driving a car. It can be
dangerous to drive too soon after having an
operation.

3 How Nimbex is given
How your injection is given
ou will never be expected to give yourself this
Y
medicine. It will always be given to you by a
person who is qualified to do so.
Nimbex can be given:
• s a single injection into your vein
a
.
(intravenous bolus injection)
. .

Following discontinuation of infusion of Nimbex, spontaneous
recovery from neuromuscular block proceeds at a rate comparable to
that following administration of a single bolus.

.
. .

Intensive Care Unit (ICU) Patients
When administered to laboratory animals in high doses, laudanosine, a
metabolite of cisatracurium and atracurium, has been associated with
transient hypotension and in some species, cerebral excitatory effects.
In the most sensitive animal species, these effects occurred at laudanosine
plasma concentrations similar to those that have been observed in some ICU
patients following prolonged infusion of atracurium.

Dosage in neonates (aged less than 1 month)
The use of Nimbex in neonates is not recommended as it has not been
studied in this patient population.
Dosage in elderly patients
No dosing alterations are required in elderly patients. In these patients
Nimbex has a similar pharmacodynamic profile to that observed in young
adult patients but, as with other neuromuscular blocking agents, it may have
a slightly slower onset.

Consistent with the decreased infusion rate requirements of cisatracurium,
plasma laudanosine concentrations are approximately one third those
following atracurium infusion.
There have been rare reports of seizures in ICU patients who have received
atracurium and other agents. These patients usually had one or more
medical conditions predisposing to seizures (eg. cranial trauma, hypoxic
encephalopathy, cerebral oedema, viral encephalitis, uraemia). A causal
relationship to laudanosine has not been established.

Dosage in patients with renal impairment
No dosing alterations are required in patients with renal failure. In these
patients Nimbex has a similar pharmacodynamic profile to that observed in
patients with normal renal function but it may have a slightly slower onset.
Dosage in patients with hepatic impairment
No dosing alterations are required in patients with end-stage liver disease.
In these patients Nimbex has a similar pharmacodynamic profile to that
observed in patients with normal hepatic function but it may have a slightly
faster onset.

Pharmaceutical Particulars

Dosage in patients with cardiovascular disease
When administered by rapid bolus injection (over 5 to 10 seconds) to adult
patients with serious cardiovascular disease (New York Heart Association
Class I-III) undergoing coronary artery bypass graft (CABG) surgery, Nimbex
has not been associated with clinically significant cardiovascular effects at
any dose studied (up to and including 0.4 mg/kg (8x ED95). However, there
are limited data for doses above 0.3 mg/kg in this patient population).

Shelf life before dilution: 2 years.

Benzene sulfonic acid solution 32% w/v, water for injections.

Shelf Life
Chemical and physical in-use stability has been demonstrated for at least
24 hours at 5°C and 25°C.
From a microbiological point of view, the product should be used
immediately. If not used immediately, in-use storage times and conditions
prior to use are the responsibility of the user and would normally not be
longer than 24 hours at 2 to 8°C, unless reconstitution has taken place in
controlled and validated aseptic conditions.

Nimbex has not been studied in children undergoing cardiac surgery.
Dosage in Intensive Care Unit (ICU) patients

Special Precautions for Storage

Nimbex may be administered by bolus dose and/or infusion to adult patients
in the ICU.

Store in a refrigerator (2 to 8°C). Do not freeze.
Store in the original package in order to protect from light.
For storage conditions of the diluted medicinal product, see section 5 of the
package leaflet.

An initial infusion rate of Nimbex of 3 µg/kg (body weight)/min
(0.18 mg/kg/hr) is recommended for adult ICU patients. There may
be wide interpatient variation in dosage requirements and these may
increase or decrease with time. In clinical studies the average infusion
rate was 3 µg/kg/min [range 0.5 to 10.2 µg/kg (body weight)/min
(0.03 to 0.6 mg/kg/hr )]

Instructions for Use/Handling
This product is for single use only. Use only clear and almost colourless up
to slightly yellow/greenish yellow coloured solutions. The product should be
visually inspected before use, and if the visual appearance has changed or if
the container is damaged, the product must be discarded.

The median time to full spontaneous recovery following long-term (up to 6
days) infusion of Nimbex in ICU patients was approximately 50 minutes.
Infusion Delivery Rate of Nimbex Forte injection 5 mg/ml

Diluted Nimbex is physically and chemically stable for at least 24 hours at
5°C and 25°C at concentrations between 0.1 and 2 mg/mL in the following
infusion fluids, in either polyvinyl chloride or polypropylene containers.

Patient
Dose (µg/kg/min)
Infusion Rate
(body weight)
(kg)
1.0
1.5
2.0
3.0
70
0.8
1.2
1.7
2.5
mL/hr
100
1.2
1.8
2.4
3.6
mL/hr
The recovery profile after infusions of Nimbex to ICU patients is independent
of duration of infusion.

Sodium Chloride (0.9% w/v) Intravenous Infusion.
Glucose (5% w/v) Intravenous Infusion.
Sodium Chloride (0.18% w/v) and Glucose (4% w/v) Intravenous Infusion.
Sodium Chloride (0.45% w/v) and Glucose (2.5% w/v) Intravenous Infusion.
However, since the product contains no antimicrobial preservative, dilution
should be carried out immediately prior to use, or failing this be stored as
directed under section 5 of the package leaflet.

Contra-Indications
Nimbex is contra-indicated in patients known to be hypersensitive to
cisatracurium, atracurium, or benzene sulfonic acid.

Nimbex has been shown to be compatible with the following commonly
used peri-operative drugs, when mixed in conditions simulating
administration into a running intravenous infusion via a Y-site injection
port: alfentanil hydrochloride, droperidol, fentanyl citrate, midazolam
hydrochloride and sufentanil citrate. Where other drugs are administered
through the same indwelling needle or cannula as Nimbex, it is
recommended that each drug be flushed through with an adequate volume
of a suitable intravenous fluid, e.g., Sodium Chloride Intravenous Infusion
(0.9% w/v).

Special Warnings and Special Precautions for Use
Cisatracurium paralyses the respiratory muscles as well as other skeletal
muscles but has no known effect on consciousness or pain threshold.
Nimbex should be only administered by or under the supervision of
anaesthetists or other clinicians who are familiar with the use and action
of neuromuscular blocking agents. Facilities for tracheal intubation, and
maintenance of pulmonary ventilation and adequate arterial oxygenation
have to be available.
Great caution should be exercised when administering Nimbex to patients
who have shown hypersensitivity to other neuromuscular blocking
agents since a high rate of cross-sensitivity (greater than 50%) between
neuromuscular blocking agents has been reported.
Cisatracurium does not have significant vagolytic or ganglion-blocking
properties. Consequently, Nimbex has no clinically significant effect on heart
rate and will not counteract the bradycardia produced by many anaesthetic
agents or by vagal stimulation during surgery.
Patients with myasthenia gravis and other forms of neuromuscular disease
have shown greatly increased sensitivity to non-depolarising blocking
agents. An initial dose of not more than 0.02 mg/kg Nimbex is recommended
in these patients.

As with other drugs administered intravenously, when a small vein is
selected as the injection site, Nimbex should be flushed through the vein
with a suitable intravenous fluid, e.g., sodium chloride intravenous infusion
(0.9% w/v).
Nimbex 2 mg/ml solution for injection/infusion
Instructions to open the ampoule (only applicable to 2 mg/ml ampoule)
Ampoules are equipped with the OPC (One Point Cut) opening system and
must be opened following the below instructions:
• old the bottom part of the ampoule with the hand as indicated in
H
picture 1
• ut the other hand on the top of the ampoule positioning the thumb
P
above the coloured point and press as indicated in picture 2

Severe acid-base and/or serum electrolyte abnormalities may increase or
decrease the sensitivity of patients to neuromuscular blocking agents.
There is no information on the use of Nimbex in neonates aged less than one
month since it has not been studied in this patient population.
Cisatracurium has not been studied in patients with a history of malignant
hyperthermia. Studies in malignant hyperthermia- susceptible pigs indicated
that cisatracurium does not trigger this syndrome.
There have been no studies of cisatracurium in patients undergoing surgery
with induced hypothermia (25 to 28°C). As with other neuromuscular
blocking agents the rate of infusion required to maintain adequate surgical
relaxation under these conditions may be expected to be significantly
reduced.

Picture 1

Picture 2

Information for the physician leaflet date: July 2010
imbex is a registered trademark of the GlaxoSmithKline group of companies
N
© 2010 GlaxoSmithKline group of companies

Cisatracurium has not been studied in patients with burns; however, as with
other non-depolarising neuromuscular blocking agents, the possibility of
increased dosing requirements and shortened duration of action must be
considered if Nimbex injection is administered to these patients.
Nimbex is hypotonic and must not be applied into the infusion line of a
blood transfusion.

• s a continuous infusion into your vein. This is
a
where the drug is slowly given to you over a
long period of time.
our doctor will decide the way you are given
Y
the drug and the dose you will receive. It will
depend on:
• our body weight
y
• he amount and duration of muscle relaxation
t
required
• our expected response to the medicine.
y
Children less than 1 month old should not have
this medicine.
If you receive more Nimbex than you should
Nimbex will always be given under carefully
controlled conditions. However, if you think that
you have been given more than you should tell
your doctor or nurse immediately.

4 Possible side effects
Like all medicines, Nimbex can cause side effects,
although not everybody gets them.
If any of the side effects gets serious, or if you
notice any side effects not listed in this leaflet,
please tell your doctor.






Allergic reactions (affects less than 1 in
10,000 people)
If you have an allergic reaction, tell your doctor
or nurse straight away. The signs may include:
• udden wheeziness, chest pain or chest
s
tightness
• welling of your eyelids, face, lips, mouth or
s
tongue
• lumpy skin rash or ‘hives’ anywhere on your
a
body
• collapse.
a
Talk to your doctor, nurse or pharmacist if you
notice any of the following:

Common (affects less than 1 in 10 people)
• ecrease in heart rate
d
• ecrease in blood pressure.
d

Uncommon (affects less than 1 in 100 people)
• rash or redness of your skin
a
• heezing or coughing.
w
Very rare (affects less than 1 in 10,000
people)
• eak or aching muscles.
w
If any of the side effects gets serious, or if you
notice any side effects not listed in this leaflet,
please tell your doctor or nurse.

5 How to store Nimbex
• eep out of the reach and sight of children.
K
• o not use Nimbex after the expiry date which
D
is stated on the pack after ‘Exp’. The expiry
date refers to the last day of that month.
• tore in a refrigerator (2°C- 8°C). Do not freeze.
S
• tore in the original package in order to
S
protect from light.
• f diluted, store the infusion solution between
I
2°C and 8°C and use within 24 hours. Any
unused infusion solution should be discarded
24 hours after it was prepared.
• edicines should not be disposed of via
M
wastewater or household waste. Your doctor
or nurse will dispose of any medicine that is
no longer required. These measures will help
to protect the environment.

6 Further information
What Nimbex contains
• he active substance is 2 mg/ml or 5 mg/ml
T
cisatracurium (as besilate).
• he other ingredients are benzene sulfonic
T
acid and water for injection.
What Nimbex looks like and contents of the
pack
Nimbex 2 mg/ml solution for injection/infusion
comes:
• .5 ml clear glass ampoule in a box of 5
2
(each 2.5 ml ampoule contains 5 mg of
cisatracurium)
• ml clear glass ampoule in a box of 5 (each
5
5 ml ampoule contains 10 mg of cisatracurium)

• 0 ml clear glass ampoule in a box of 5
1
(each 10 ml ampoule contains 20 mg of
cisatracurium)
• 5 ml clear glass ampoule in a box of 2
2
(each 25 ml ampoule contains 50 mg of
cisatracurium)
Nimbex Forte 5 mg/ml solution for
injection/infusion comes in a box containing one
30 ml clear glass vial. Each 30 ml vial contains
150 mg of cisatracurium.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and
Manufacturer
Marketing Authorisation holder:
GlaxoSmithKline UK, Stockley Park West,
Uxbridge, Middlesex UB11 1BT
Manufacturer:
GlaxoSmithKline Manufacturing S.p.A.,
Strada Provinciale Asolana 90,
43056 San Polo di Torrile, Parma, Italy.
Other formats:
To listen to or request a copy of this leaflet
in Braille, large print or audio please call,
free of charge:
800 198 5000 (UK only).
0
Please be ready to give the following
information:
Product name
Nimbex 2 mg/ml solution for injection
Nimbex Forte 5 mg/ml solution for
injection
Reference number
00003/0364
This is a service provided by the Royal National
Institute of Blind People.
Leaflet date: July 2010
Nimbex is a registered trademark of the
.
GlaxoSmithKline group of companies
. .
2010 GlaxoSmithKline group of
©
companies
10000000083778

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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