NAME OF DRUG
dantrolene sodium

CLASSIFICATION

Skeletal Muscle Relaxant

ALTERNATE NAME

DANTRIUM

INDICATIONS

• management of malignant hyperthermia crisis

RECONSTITUTION AND STABILITY

• each vial should be reconstituted by adding 60 mL of sterile water for injection WITHOUT bacteriostatic agent and shaken until solution is clear
• protect reconstituted solution from light, use within 6 hours of reconstitution, keep at room temperature
• discard unused portion

COMPATIBILITY

• compatible only with sterile water for injection

NB: only water for injection WITHOUT bacteriostatic agent must be used since large volume of diluent required would provide toxic amounts of bacteriostatic agent

ROUTES OF ADMINISTRATION

• IV direct only - rapid injection over 1-2 minutes
• IV infusion - add reconstituted solution to empty sterile bag; infuse over 1 hour

VH & HSC ADMINISTRATION POLICY

C - Must be administered by the physician by all routes.

DOSAGE

MANAGEMENT OF MALIGNANT HYPERTHERMIA

Adults and Children:

Treatment: Initially 1 mg/kg given rapidly - may be repeated if physiologic and metabolic abnormalities persist or reappear.  Reversal of malignant hyperthermia usually achieved with an average total IV dosage of 2.5 mg/kg.

Prevention: 2.5 mg/kg infused IV over 1 hour beginning 75 minutes before anesthesia. 

Total IV dosage should not exceed 10 mg/kg.

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• use care to prevent extravasation of the solution into surrounding tissues due to its high pH (9.5); symptomatic treatment of extravasation includes warm or cold compresses to the area of inflammation.  Where cellulitis develops after extravasation, the use of appropriate antibiotic therapy is indicated.

IMPORTANT IMPLICATIONS

• adverse reactions to dantrolene sodium include:  drowsiness, headaches, dizziness, vertigo, fatigue, giddiness, somnolence, nausea and vomiting, abdominal cramps, diarrhea
• use cautiously in patients with previous liver disease or dysfunction, impaired pulmonary function, impaired cardiac function
• concurrent administration of IV dantrolene and verapamil has resulted in ventricular fibrillation, cardiovascular collapse and hyperkalemia; concurrent administration of IV dantrolene and other calcium channel blockers may produce similar adverse effects

Rev. November 1998