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Dantrium

Generic Name: Dantrolene Sodium
Class: Direct-acting Skeletal Muscle Relaxants
VA Class: MS200
Chemical Name: 1-[[[5-(4-Nitrophenyl)-2-furanyl]methylene]amino]-2,4-imidazolidinedione sodium salt, hydrate (2:7)
Molecular Formula: C14H9N4NaO5•3½H2O
CAS Number: 24868-20-0

Medically reviewed on Oct 15, 2018

Warning

    Hepatic Effects of Oral Dantrolene
  • Risk of developing potentially fatal, hepatic injury (e.g., hepatitis); should not be used for unlabeled indications.109

  • Females, patients >35 years of age, and those receiving other drugs (especially estrogens) concomitantly are at greatest risk.109

  • Possible higher risk in geriatric patients.109 (See Geriatric Use under Cautions.)

  • Risk of symptomatic hepatitis (fatal and nonfatal) may be dose dependent; incidence much higher at dosages ≥800 mg daily than at dosages ≤400 mg daily.109 Even intermittent, short courses at higher dosages associated with increased risk.109 Use lowest possible effective dose.109

  • Overt hepatitis most frequently observed between 3rd and 12th month of therapy.109

  • Frequently monitor hepatic function.109 (See Hepatic Effects under Cautions.)

  • If benefits are not evident within 45 days, discontinue therapy.109

Introduction

Skeletal muscle relaxant.108 109 115 116 117 119

Uses for Dantrium

Spasticity

Used orally for management of spasticity resulting from upper motor neuron disorders (e.g., multiple sclerosis, cerebral palsy, spinal cord injury, stroke syndrome).109 a

Evidence supporting use is limited and the drug is associated with many adverse effects, some of which may be severe (e.g., hepatotoxicity);123 124 125 126 127 128 130 however, subtle but meaningful improvement (e.g., decrease in severity of spasticity, ability to resume daily function) may occasionally occur in some patients.109

Ineffective in the treatment of amyotrophic lateral sclerosis (ALS).a

Not indicated for the treatment of muscle spasms resulting from rheumatic disorders or musculoskeletal trauma.109 a

Malignant Hyperthermia Crisis

IV treatment of fulminant hypermetabolism of skeletal muscle that is characteristic of malignant hyperthermia crisis;108 115 116 117 should be used with and not as a substitute for supportive measures (e.g., oxygen, treatment of metabolic acidosis, cooling procedures).108 115 116 117

Dantrolene sodium for injectable suspension (Ryanodex) is designated an orphan drug by FDA for this use.122

Also has been used preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible individuals;108 109 115 116 117 however, prophylactic use no longer recommended because of adverse effects and questionable benefit.114 119

Neuroleptic Malignant Syndrome

Has been used for the treatment of neuroleptic malignant syndrome; fatalities reported despite therapy with the drug.100 101 102 103 104 105 108 109 115 116

Dantrium Dosage and Administration

General

    Spasticity
  • Establish therapeutic goal before initiating therapy.109 Use lowest possible effective dosage.109 Discontinue drug if beneficial effects are not attained within 45 days.109 (See Boxed Warning.)

  • Subjective impressions of improvement may sometimes be confirmed by withdrawal of the drug for 2–4 days.109

    Malignant Hyperthermia Crisis
  • Immediately discontinue all anesthetic agents or other potential triggering agents (e.g., succinylcholine) and institute IV dantrolene as soon as malignant hyperthermia crisis is recognized.108 115 116 117

  • Use in conjunction with supportive measures.108 115 116 117

  • When using injectable suspension formulation, administer a diuretic to prevent late kidney injury due to myoglobinuria; amount of mannitol contained in formulation is insufficient to maintain diuresis.113 117

  • When used preoperatively for prophylaxis, monitor for early clinical and metabolic signs of malignant hyperthermia; monitor vital signs (e.g., for possible respiratory depression).108 115 116

Administration

Administer orally or by continuous IV infusion or rapid IV injection.108 109 115 116 117

Oral Administration

Administer orally 1–4 times daily.109

Extemporaneous Suspension

To prepare an oral suspension containing 25 mg of dantrolene sodium per 5 mL, empty five 100-mg capsules in a small amount of simple syrup NF, then add a solution containing 150 mg of citric acid in 10 mL of water followed by a sufficient volume of simple syrup NF to make 100 mL.118 Mix thoroughly before use.118 Other extemporaneously prepared suspensions of dantrolene also have been described.112 118

IV Administration

For solution compatibility information, see Compatibility under Stability.

Administer by rapid IV injection for acute treatment of malignant hyperthermia.108 115 116 117 May administer by IV infusion for prevention of malignant hyperthermia.108 115 116 117

Commercially available as a lyophilized drug for injection (e.g., Dantrium, Revonto, or generic equivalents) or a lyophilized drug for injectable suspension (Ryanodex).108 115 116 117 Reconstitution procedures differ based on the preparation; consult manufacturer’s prescribing information for specific instructions.108 115 116 117

Avoid extravasation (injection has high pH and can cause tissue necrosis).108 115 116 117

Reconstitution and Administration

Dantrolene sodium for injection: Add 60 mL of sterile water for injection (without bacteriostatic agent) to vial containing 20 mg of the drug.108 115 116 Do not reconstitute with any other solution.108 115 116 Shake vial until solution is clear.108 115 116 Use reconstituted solution within 6 hours of reconstitution.108 115 116 For administration by IV infusion, transfer desired volume of reconstituted solution to an appropriate-size empty sterile IV plastic bag.108 115 116 Do not transfer to large glass containers because precipitate formation has been observed.108 115 116

Dantrolene sodium for injectable suspension: Add 5 mL of sterile water for injection (without bacteriostatic agent) to vial containing 250 mg of the drug.117 Do not reconstitute with any other solution.117 Shake vial until an orange-colored uniform suspension is formed.117 Do not dilute or transfer reconstituted suspension to another container.117 Use reconstituted suspension within 6 hours after reconstitution.117 May administer reconstituted suspension into the IV catheter of a freely running IV infusion of 0.9% sodium chloride or 5% dextrose for injection, or into an indwelling catheter (after assuring its patency) without a freely running IV infusion.117 If an indwelling catheter is used, flush line to assure that there is no residual drug remaining in the catheter.117

Rate of Administration

Acute management of malignant hyperthermia crisis: Rapid IV injection.108 115 116 117

Preoperative prophylaxis of malignant hyperthermia: Infuse IV over approximately 1 hour (for Dantrium, Revonto or generic equivalents) or over at least 1 minute (for Ryanodex).108 115 116 117

Dosage

Available as dantrolene sodium; dosage expressed in terms of the salt.108 109 115 116 117

Pediatric Patients

Spasticity
Oral

Children ≥5 years of age: 0.5 mg/kg once daily for 7 days, followed by 0.5 mg/kg 3 times daily for 7 days, then 1 mg/kg 3 times daily for 7 days, and then 2 mg/kg 3 times daily, if necessary.109 Some patients may require doses 4 times daily.109

If no additional benefit is observed at the next higher dosage, decrease dosage to the previous (lower) dosage.109

Malignant Hyperthermia Crisis
Preoperative Prophylaxis
Oral

4–8 mg/kg daily in 3 or 4 divided doses for 1–2 days prior to surgery; give the last dose approximately 3–4 hours before surgery with small amount of water.109

IV

2.5 mg/kg infused over approximately 1 hour (Dantrium, Revonto, or generic equivalents) or at least 1 minute (Ryanodex), beginning about 1.25 hours before anticipated anesthesia or surgery; may give additional individualized doses intraoperatively, if necessary.108 115 116 117

Treatment
IV

Initially, 1 mg/kg or more by rapid IV injection.108 115 116 117 Administer continuous rapid IV injections as necessary until physiologic and metabolic abnormalities subside or a maximum total dosage of 10 mg/kg is reached.108 115 116 117

Effective dosage will vary between patients based on their susceptibility to malignant hyperthermia, amount and time of exposure to the triggering agent, and rapidity of treatment.108

Repeat regimen if physiologic and metabolic abnormalities reappear.108 115 116 117

Post-crisis Follow-up
Oral

To prevent recurrence, 4–8 mg/kg daily in 4 divided doses for up to 3 days after the crisis.108 109 115 116

IV

If oral therapy not practical or feasible, may administer IV starting with a dose of 1 mg/kg or more as clinically indicated based on individual requirements.108 115 116

Adults

Spasticity
Oral

Initially, 25 mg once daily for 7 days, followed by 25 mg 3 times daily for 7 days, then 50 mg 3 times daily for 7 days, and then 100 mg 3 times daily, if necessary.109 Some patients may require doses 4 times daily.109

If no additional benefit is observed at the next higher dosage, decrease dosage to the previous (lower) dosage.109

Malignant Hyperthermia Crisis
Preoperative Prophylaxis
Oral

4–8 mg/kg daily in 3 or 4 divided doses for 1–2 days prior to surgery; give the last dose approximately 3–4 hours before surgery with small amount of water.109

IV

2.5 mg/kg infused over approximately 1 hour (Dantrium, Revonto, or generic equivalents) or over at least 1 minute (Ryanodex), beginning about 1.25 hours before anticipated anesthesia or surgery; may give additional individualized doses intraoperatively, if necessary.108 115 116 117

Treatment
IV

Initially, 1 mg/kg or more by rapid IV injection.108 115 116 117 Administer continuous rapid IV injections as necessary until physiologic and metabolic abnormalities subside or a maximum total dosage of 10 mg/kg is reached.108 115 116 117

Effective dosage will vary between patients based on their susceptibility to malignant hyperthermia, amount and time of exposure to the triggering agent, and rapidity of treatment.108

Repeat regimen if physiologic and metabolic abnormalities reappear.108 115 116 117

Post-crisis Follow-up
Oral

To prevent recurrence, 4–8 mg/kg daily in 4 divided doses for up to 3 days after the crisis.108 109 115 116

IV

If oral therapy not practical or feasible, may administer IV starting with a dose of 1 mg/kg or more as clinically indicated based on individual requirements.108 115 116

Prescribing Limits

Pediatric Patients

Spasticity
Oral

Maximum 100 mg 4 times daily.109

Malignant Hyperthermia Crisis
Treatment
IV

Maximum total dose of 10 mg/kg.108 115 116 117

Adults

Spasticity
Oral

Maximum 100 mg 4 times daily.109

Malignant Hyperthermia Crisis
Treatment
IV

Maximum total dose of 10 mg/kg.108 115 116 117

Cautions for Dantrium

Contraindications

  • Oral dantrolene contraindicated in patients with active hepatic disease (e.g., hepatitis, cirrhosis).109

  • Also contraindicated in patients who must utilize spasticity to maintain upright posture and balance in moving or to obtain or maintain increased body function.109

  • No contraindications to IV dantrolene for prophylaxis or management of malignant hyperthermia crisis.108 115 116 117

Warnings/Precautions

Warnings

Hepatic Effects

Fatal and nonfatal hepatic disorders of idiosyncratic or hypersensitivity type possible with oral dantrolene.108 109 (See Boxed Warning.)

Obtain serum AST, ALT, alkaline phosphatase, and total bilirubin concentrations prior to and periodically during therapy or whenever symptoms of hepatitis occur.109

If liver function test abnormalities occur alone, consider discontinuing therapy; continue or reinstitute the drug only if major benefits occurred during dantrolene therapy.109

If symptoms of hepatitis are accompanied by liver function test abnormalities or jaundice, discontinue dantrolene.109

Following discontinuance for clinical and/or laboratory evidence of hepatotoxicity, reinstitute dantrolene only in patients who clearly need the drug and only after symptoms and laboratory abnormalities of hepatotoxicity have resolved.109 Hospitalize patient to reinitiate therapy with very small doses; gradually increase dosage with frequent monitoring of liver function; discontinue drug immediately if signs of liver abnormality recur.109

Sensitivity Reactions

Photosensitivity

Possible photosensitivity reactions; limit exposure to sunlight.109

Other Warnings/Precautions

Supportive Therapy

In the treatment of malignant hyperthermia, must use in conjunction with supportive measures (e.g., oxygen, treatment of metabolic acidosis, cooling procedures) and discontinue all suspect triggering agents (e.g., inhaled anesthetics, succinylcholine); monitor urinary output and serum electrolytes.108 115 116 117 Use of IV dantrolene is not a substitute for these supportive measures.108 115 116

Musculoskeletal Effects

Skeletal muscle weakness (e.g., loss of grip strength, leg weakness) may occur with IV dantrolene.108 117 Patients should not be permitted to ambulate without assistance until normal strength and balance return.117

Dysphagia reported; monitor patients for difficulty swallowing and choking.108 117

Administration Precautions

Injection site reactions (pain, erythema, swelling), commonly due to extravasation, reported with IV dantrolene therapy.108 115 116 117 IV formulations have high pH; care must be taken to prevent extravasation.108 115 116 117

Mannitol Content

If mannitol is used for prevention or treatment of late renal complications of malignant hyperthermia, consider the amount of mannitol in the IV dantrolene formulation (e.g., 3 g of mannitol per 20-mg vial of Dantrium, Revonto, or generic equivalents; 125 mg of mannitol per 250-mg vial of Ryanodex) as part of the total amount administered.108 115 116 117 (See General under Dosage and Administration.)

Concomitant Conditions

Use with caution in patients with severe cardiac impairment secondary to myocardial disease or with impaired pulmonary function (particularly obstructive pulmonary disease).109

CNS Effects

Drowsiness and dizziness may occur, and may persist for up to 48 hours.108 115 116 117 Performance of activities requiring mental alertness may be impaired.109 (See Advice to Patients.)

Concurrent use of other CNS depressants may cause additive CNS effects.109 117 (See Specific Drugs under Interactions.)

Respiratory Effects

Respiratory effects including respiratory depression, a feeling of suffocation, dyspnea, respiratory muscle weakness, and decreased inspiratory capacity reported.109 117 Use with caution in patients with impaired pulmonary function.109 Monitor patients for adequate ventilation and vital signs.108 117

Rarely, pulmonary edema has developed during treatment of malignant hyperthermia crisis in which the diluent volume and amount of mannitol associated with IV dantrolene may have contributed.108 115 116

Specific Populations

Pregnancy

Category C.108 109 115 116 117

No adequate and well-controlled studies in pregnant women.108 109 115 116 117 Embryocidal effects and decreased pup survival observed in animal studies.108 115 116 117

Readily crosses the placenta.108 109 115 116 117 (See Distribution under Pharmacokinetics.)

Lactation

Distributed into milk;108 115 116 117 discontinue nursing or the drug.108 115 116 117

Pediatric Use

Long-term safety of oral dantrolene not established in children <5 years of age.109

Weigh possible risks against potential benefits before initiating long-term oral therapy; adverse effects may become evident only after many years.109

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.108 109 115 116 117

Spontaneous reports suggest that geriatric patients receiving oral dantrolene may have a higher risk of hepatic events with fatal outcomes; however, majority of these reports were complicated by confounding factors (e.g., comorbid illnesses, concomitant use of hepatotoxic drugs).109

Titrate dosage carefully.108 109 115 116 117

Hepatic Impairment

Use with caution in patients with a history of hepatic impairment.109

Common Adverse Effects

Oral or IV: Muscle weakness,108 109 115 116 117 drowsiness,108 109 115 116 117 dizziness,108 109 115 116 117 lightheadedness,108 115 116 diarrhea,109 nausea,109 117 malaise,109 fatigue.109

IV: thrombophlebitis,108 115 116 117 tissue necrosis secondary to extravasation,108 115 116 117 urticaria,108 115 116 117 erythema,108 115 116 117 injection site reactions (pain, erythema, swelling).108 115 116 117

Interactions for Dantrium

Metabolized in the liver.108 109 115 116 117

Drugs Affecting Hepatic Microsomal Enzymes

Pharmacokinetic interaction with CYP enzyme inducers theoretically possible.108 109 115 116 117

Specific Drugs

Drug

Interaction

Comment

Calcium-channel blockers (e.g., verapamil)

Cardiovascular collapse reported rarely109

Concomitant use during management of malignant hyperthermia not recommended108 109 115 116 117

Clofibrate

Decreased binding of dantrolene to plasma proteins108 115 116 117

CNS depressants

Possible additive CNS effects (e.g., dizziness)109 117

Use with caution109

Diazepam

Additive sedative effect; dantrolene metabolism and protein binding unaffected108 109 115 116 117

Use with caution109

Estrogens

Possible increased frequency of hepatotoxicity in women >35 years of age109

Potential for interaction not clearly established; use with caution109

Muscle relaxants

Potentiation of neuromuscular block117

Phenobarbital

Pharmacokinetic interaction unlikely; dantrolene metabolism unaffected108 109 115 116 117

Phenytoin

No change in binding of dantrolene to plasma proteins108 115 116

Tolbutamide

Increased binding of dantrolene to plasma proteins108 115 116 117

Vecuronium

Potentiation of vecuronium-induced neuromuscular blockade108 109 115 116

Warfarin

Decreased binding of dantrolene to plasma proteins108 115 116 117

Dantrium Pharmacokinetics

Absorption

Bioavailability

Absorption following oral administration is incomplete and slow but consistent.109 Oral bioavailability is 70%.119 120

Distribution

Extent

Readily crosses the placenta, with maternal and fetal whole blood concentrations approximately equal at delivery; neonatal concentrations then fall approximately 50% per day for 2 days before declining sharply.108 109 115 116 117

Plasma Protein Binding

Substantially bound to plasma proteins (mostly albumin); binding is readily reversible.108 115 116 117

Elimination

Metabolism

Major metabolites are 5-hydroxydantrolene and an acetylamino metabolite.108 115 116 117 May undergo hydrolysis and subsequent oxidation forming nitrophenylfuroic acid.108 115 116 117

Elimination Route

Mainly excreted in urine and bile.119

Half-life

Approximately 4–11.4 hours following IV administration.108 115 116 117

Approximately 9 hours (depending on preparation) following oral administration in adults.109

Stability

Storage

Oral

Capsules

20–25°C.109

Parenteral

Powder for Injection

Dantrium: 20–25°C.108 Avoid prolonged exposure to light.108 Store reconstituted solutions at 15–30°C for ≤6 hours; protect from light.108

Revonto or generic dantrolene sodium for injection: 20–25°C. 115 116 Avoid prolonged exposure to light.115 116 Store reconstituted solutions at 20–25°C for ≤6 hours; protect from direct light.115 116

Powder for Injectable Suspension

Ryanodex: 20–25°C (may be exposed to 15–30°C).117 Avoid prolonged exposure to light.117 Store reconstituted suspension at 20–25°C for ≤6 hours.117

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility

Dantrolene sodium for injection (Dantrium, Revonto, or generic equivalents) is incompatible with sodium chloride 0.9% and dextrose 5% injection.108 115 116

Reconstituted dantrolene sodium suspension (Ryanodex) is compatible with small amounts of sodium chloride 0.9% or dextrose 5% injection when administered into the IV catheter of a freely running IV infusion of these solutions.113 117

Actions

  • Causes skeletal muscle relaxation through a direct effect on skeletal muscle, probably by interfering with release of calcium from the sarcoplasmic reticulum.108 109 115 116 117 119

  • Interference with calcium release from the sarcoplasmic reticulum may prevent the increase in myoplasmic calcium that activates acute catabolism of skeletal muscle cells in patients with anesthesia-induced malignant hyperthermia.108 115 116 117

  • Has little or no effect on the contraction of cardiac or intestinal smooth muscle, except possibly at concentrations higher than those required for effects on skeletal muscle contraction.a

Advice to Patients

  • Risk of hepatotoxicity with oral dantrolene.108 109

  • Risk of dizziness, somnolence, and muscle weakness; do not ambulate without assistance until strength and balance have returned to normal.108 109 115 116 117 Do not drive or operate machinery within 48 hours of receiving IV dantrolene.108 115 116 117

  • Risk of choking and difficulty swallowing; exercise caution during meals.108 115 116 117

  • Risk of photosensitivity reactions; limit exposure to sunlight.109

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.108 109 115 116 117

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, alcohol consumption, and any concomitant illnesses.108 109 115 116 117

  • Importance of informing patients of other important precautionary information.108 109 115 116 117 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dantrolene Sodium

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

25 mg*

Dantrium

Par

Dantrolene Sodium Capsules

50 mg*

Dantrium

Par

Dantrolene Sodium Capsules

100 mg*

Dantrium

Par

Dantrolene Sodium Capsules

Parenteral

For injection

20 mg*

Dantrium Intravenous

Par

Dantrolene Sodium for Injection

Revonto

US WorldMeds

For injectable suspension

250 mg

Ryanodex

Eagle

AHFS DI Essentials™. © Copyright 2018, Selected Revisions October 15, 2018. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

48. Schmidt RT, Lee RH, Spehlmann R. Comparison of dantrolene sodium and diazepam in the treatment of spasticity. J Neurol Neurosurg Psychiatry. 1976; 39:350-6. http://www.ncbi.nlm.nih.gov/pubmed/778344?dopt=AbstractPlus

49. Glass A, Hannah A. A comparison of dantrolene sodium and diazepam in the treatment of spasticity. Paraplegia. 1974; 12:170-4. http://www.ncbi.nlm.nih.gov/pubmed/4616209?dopt=AbstractPlus

100. Coons DJ, Hillman FJ, Marshall RW. Treatment of neuroleptic malignant syndrome with dantrolene sodium: a case report. Am J Psychiatry. 1982; 139:944-5. http://www.ncbi.nlm.nih.gov/pubmed/6124135?dopt=AbstractPlus

101. Goekoop JG, Carbaat PAT. Treatment of neuroleptic malignant syndrome with dantrolene. Lancet. 1982; 2:49-50.

102. May DC, Morris SW, Stewart RM et al. Neuroleptic malignant syndrome: response to dantrolene sodium. Ann Intern Med. 1983; 98:183-4. http://www.ncbi.nlm.nih.gov/pubmed/6824251?dopt=AbstractPlus

103. Daoudal P, Delacour JL. Treatment of neuroleptic malignant syndrome with dantrolene. Lancet. 1982; 2:217. http://www.ncbi.nlm.nih.gov/pubmed/6123917?dopt=AbstractPlus

104. Granato JE, Stern BJ, Ringel A et al. Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine. Ann Neurol. 1983; 14:89-90. http://www.ncbi.nlm.nih.gov/pubmed/6614876?dopt=AbstractPlus

105. Goulon M, de Rohan-Chabot P, Elkharrat D et al. Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: a report of the two cases. Neurology. 1983; 33:516-8. http://www.ncbi.nlm.nih.gov/pubmed/6682201?dopt=AbstractPlus

106. Rappaport PL. Extemporaneous dosage preparations for pediatrics. Can J Hosp Pharm. 1983; 36:66-70,74. http://www.ncbi.nlm.nih.gov/pubmed/10262678?dopt=AbstractPlus

107. Kaplan RF, Feinglass NG, Webster W et al. Phenelzine overdose treated with dantrolene sodium. JAMA. 1986; 255:642-4. http://www.ncbi.nlm.nih.gov/pubmed/3944965?dopt=AbstractPlus

108. Par Pharmaceutical. Dantrium IV (dantrolene sodium) for injection prescribing information. Chestnut Ridge, NY; 2016 Jul.

109. Par Pharmaceutical. Dantrium (dantrolene sodium) capsules prescribing information. Chestnut Ridge, NY; 2015 Oct.

110. Rubin AS, Zablocki AD. Hyperkalemia, verapamil, and dantrolene. Anesthesiology. 1987; 66:246-9. http://www.ncbi.nlm.nih.gov/pubmed/3813090?dopt=AbstractPlus

111. Dantrolene (Dantrium) interactions: verapamil (e.g., Calan). In: Hansten PD, Horn JR. Hansten and Horn’s drug interactions, analysis and managements. St. Louis, MO. Facts and Comparisons; 2002:450a.

112. Fawcett JP, Stark G, Tucker IG et al. Stability of dantrolene oral suspension prepared from capsules. J Clin Pharm Ther. 1994; 19:349-53. http://www.ncbi.nlm.nih.gov/pubmed/7876365?dopt=AbstractPlus

113. Food and Drug Administration. Center for Drug Evaluation and Research: Application number 205579Orig1s000: summary review. From FDA website. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/205579Orig1s000SumR.pdf

114. Malignant Hyperthermia Association of the United States. FAQs: Should MHS patients be pretreated with Dantrolene?. From MHAUS website. Accessed 2018 Jan 17. https://www.mhaus.org/faqs/should-mhs-patients-be-pretreated-with-dantrolene/

115. Westward Pharmaceuticals. Dantrolene sodium for injection prescribing information. Eatontown, NJ; 2017 Oct.

116. US WorldMeds. Revonto (dantrolene sodium) for injection prescribing information. Louisville, KY; 2016 Oct.

117. Eagle Pharmaceuticals. Ryanodex (dantrolene sodium) for injectable suspension prescribing information. Woodcliff Lake, NJ; 2016 Oct.

118. Nahata MC, Pai VB. Pediatric drug formulations. 6th ed., revised. Cincinnati, Ohio: Harvey Whitney Books Company; 2014.

119. Krause T, Gerbershagen MU, Fiege M et al. Dantrolene--a review of its pharmacology, therapeutic use and new developments. Anaesthesia. 2004; 59:364-73. http://www.ncbi.nlm.nih.gov/pubmed/15023108?dopt=AbstractPlus

120. Allen GC, Cattran CB, Peterson RG et al. Plasma levels of dantrolene following oral administration in malignant hyperthermia-susceptible patients. Anesthesiology. 1988; 69:900-4. http://www.ncbi.nlm.nih.gov/pubmed/3057938?dopt=AbstractPlus

121. . Ryanodex--A New Dantrolene Formulation for Malignant Hyperthermia. Med Lett Drugs Ther. 2015; 57:100. http://www.ncbi.nlm.nih.gov/pubmed/26147894?dopt=AbstractPlus

122. Food and Drug Administration. FDA Application: Search Orphan Drug Designations and Approvals. Silver Spring, MD. From FDA website. Accessed 2017 Dec 18. https://www.accessdata.fda.gov/scripts/opdlisting/oopd/listResult.cfm

123. Taricco M, Pagliacci MC, Telaro E et al. Pharmacological interventions for spasticity following spinal cord injury: results of a Cochrane systematic review. Eura Medicophys. 2006; 42:5-15. http://www.ncbi.nlm.nih.gov/pubmed/16565680?dopt=AbstractPlus

124. Thompson AJ, Jarrett L, Lockley L et al. Clinical management of spasticity. J Neurol Neurosurg Psychiatry. 2005; 76:459-63. http://www.ncbi.nlm.nih.gov/pubmed/15774425?dopt=AbstractPlus

125. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society, Delgado MR, Hirtz D et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010; 74:336-43. http://www.ncbi.nlm.nih.gov/pubmed/20101040?dopt=AbstractPlus

126. Chang E, Ghosh N, Yanni D et al. A Review of Spasticity Treatments: Pharmacological and Interventional Approaches. Crit Rev Phys Rehabil Med. 2013; 25:11-22. http://www.ncbi.nlm.nih.gov/pubmed/25750484?dopt=AbstractPlus

127. Abbruzzese G. The medical management of spasticity. Eur J Neurol. 2002; 9 Suppl 1:30-4; discussion 53-61. http://www.ncbi.nlm.nih.gov/pubmed/11918647?dopt=AbstractPlus

128. Shakespeare DT, Boggild M, Young C. Anti-spasticity agents for multiple sclerosis. Cochrane Database Syst Rev. 2003; :CD001332. http://www.ncbi.nlm.nih.gov/pubmed/14583932?dopt=AbstractPlus

129. Elbasiouny SM, Moroz D, Bakr MM et al. Management of spasticity after spinal cord injury: current techniques and future directions. Neurorehabil Neural Repair. 2010; 24:23-33. http://www.ncbi.nlm.nih.gov/pubmed/19723923?dopt=AbstractPlus

130. Taricco M, Adone R, Pagliacci C et al. Pharmacological interventions for spasticity following spinal cord injury. Cochrane Database Syst Rev. 2000; :CD001131. http://www.ncbi.nlm.nih.gov/pubmed/10796750?dopt=AbstractPlus

131. Francisco GE, McGuire JR. Poststroke spasticity management. Stroke. 2012; 43:3132-6. http://www.ncbi.nlm.nih.gov/pubmed/22984012?dopt=AbstractPlus

a. AHFS Drug Information. McEvoy GK, ed. Dantrolene. Bethesda, MD: American Society of Health-System Pharmacists.

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