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Pronunciation: dan-troe-LEEN SO-dee-uhm
Class: Skeletal muscle relaxant
- Capsules 25 mg
- Capsules 50 mg
- Capsules 100 mg
- Powder for Injection 20 mg/vial
- Lyophilized Powder for Injection 20 mg/vial
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.
Absorption is incomplete and slow, but consistent.
Significantly protein bound, mostly albumin.
Metabolized in the liver to the major metabolites 5-hydroxy dantrole and an acetylamino metabolite.
Half-life is 4 to 8 h (IV) and 9 h (oral).
Indications and Usage
Control of spasticity associated with spinal cord injury, stroke, cerebral palsy or multiple sclerosis; prophylaxis, treatment and postcrisis therapy of malignant hyperthermia.
Management of exercise-induced muscle pain, neuroleptic malignant syndrome, heat stroke.
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.
Dosage and AdministrationChronic Spasticity
PO Initial dose 25 mg every day; increase at 4 to 7 day intervals to 25 mg twice daily to 4 times daily, up to max 100 mg twice daily to 4 times daily, if necessary.Children
PO Initial dose 0.5 mg/kg twice daily; increase to 0.5 mg/kg 3 times daily to 4 times daily, then by increments of 0.5 mg/kg, up to 3 mg/kg twice daily to 4 times daily, if necessary. Max 100 mg 4 times daily.Malignant Hyperthermia
Adults and 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 h before surgery or IV 2.5 mg/kg approximately 75 min before anesthesia. Infused over 1 h. May repeat during surgery, if needed.Treatment
IV 1 mg/kg by continuous rapid push; evaluate and repeat as needed or until cumulative total dose is up to 10 mg/kg. May be repeated if psysiologic and metabolic abnormalities reappear.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 at least 1 mg/kg, as needed.
- 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 vial for approximately 20 sec or until solution is clear.
- Do not transfer reconsitituted dantrolene to large glass bottles for prophylactic infusion.
- Dextrose 5% injection, sodium chloride 0.9% injection, and other acidic solutions are not compatible.
Store vials and reconstituted dantrolene between 68° and 77°F. Protect from direct light. Use reconstituted solutions within 6 h of reconstitution.
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.
Caused by oral administration except where otherwise indicated.
Erratic BP, phlebitis, tachycardia.
Dizziness; drowsiness; fatigue; general malaise; headache; increased nervousness; insomnia, mental depression or confusion; lightheadedness; seizures; speech disturbances; weakness.
Abnormal hair growth, acne-like rash, eczematoid eruption, erythema (IV), pruritus, sweating, urticaria (IV).
Visual disturbance, diplopia, alteration of taste.
Abdominal cramps, anorexia, constipation, bleeding, diarrhea, dysphagia, gastric irritation.
Crystalluria, difficult erection, dysuria, hematuria, increased urinary frequency, nocturia, urinary incontinence, urinary retention.
Pleural effusion with pericarditis, pulmonary edema (IV).
Backache, chills, excessive tearing, fever, feeling of suffocation, myalgia, thrombophlebitis (IV).
Should not be used in conditions other than those recommended.Hepatotoxicity
The incidence of symptomatic (fatal and nonfatal) hepatitis is lower with doses up to 400 mg/day compared with 800 mg/day or greater. Overt hepatitis was most frequent during the third and twelfth mo, but may occur at anytime. Risk is higher in females, patients older than 35 y, and with concurrent therapy. Use only in conjunction with liver monitoring.
Category C (parenteral).
Excreted in breast milk. Do not use in breast-feeding women.
Safety in children younger than 5 y of age not established.
Fatal and nonfatal liver disorders may occur; use drug with caution in patients with preexisting hepatic impairment and in women and patients older than 35 y of age.
Special Risk Patients
Use drug with caution in patients with impaired pulmonary function (especially COPD) or cardiac function.
Photosensitization may occur.
Because of the high pH of the IV formulation, prevent extravasation into the surrounding tissue.
IV dantrolene is also associated with the loss of grip strength and weakness in the legs.
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.
Supportive care should be foremost in treatment (ie, concurrent with dantrolene therapy).
- 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 patients to report these symptoms to their health care provider: weakness, malaise, fatigue, nausea, diarrhea, skin rash, itching, bloody or black tarry stools, 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.
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