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(dan-troe-LEEN SO-dee-uhm)
Dantrium; Dantrium Intravenous
Class: Skeletal muscle relaxant/direct acting

 Action 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.

 Indications Control of spasticity associated with spinal cord injury, stroke, cerebral palsy or multiple sclerosis; prophylaxis, treatment and postcrisis therapy of malignant hyperthermia. Unlabeled use(s): Management of exercise-induced muscle pain, neuroleptic malignant syndrome, heat stroke.

 Contraindications 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.

 Route/Dosage

Chronic Spasticity

ADULT: PO Initial dose: 25 mg q day; increase at 4 to 7 day intervals to 25 mg bid to qid, up to max of 100 mg bid to qid if necessary. CHILDREN: PO Initial dose: 0.5 mg/kg bid; increase to 0.5 mg/kg tid to qid, then by increments of 0.5 mg/kg, up to 3 mg/kg bid to qid, if necessary. Maximum 100 mg qid.

Malignant Hyperthermia

ADULTS & 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 hrs before surgery or IV 2.5 mg/kg » 1¼ hrs before anesthesia. Infused over 1 hr. May repeat during surgery, if needed. Treatment: IV 1 mg/kg by continuous rapid push; evaluate and repeat as needed until cumulative total dose is £ 10 mg/kg. 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 ³ 1 mg/kg, as needed.

 Interactions

Clofibrate: 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.

 Lab Test Interferences None well documented.

 Adverse Reactions

Due to oral administration except where otherwise indicated.

CV: Tachycardia; erratic blood pressure; phlebitis. CNS: Drowsiness; dizziness; weakness; general malaise; fatigue; speech disturbances; seizures; headache; lightheadedness; insomnia, mental depression or confusion; increased nervousness. DERM: Abnormal hair growth; acne-like rash; pruritus; urticaria (IV); eczematoid eruption; sweating; erythema (IV). EENT Visual disturbance, diplopia, alteration of taste. GI: Diarrhea; constipation; bleeding; anorexia; dysphagia; gastric irritation; abdominal cramps. GU Increased urinary frequency; hematuria; crystalluria; difficult erection; urinary incontinence; nocturia; dysuria; urinary retention. HEPA Hepatitis. RESP: Pleural effusion with pericarditis; pulmonary edema (IV). OTHER: Myalgia; backache; chills; fever; feeling of suffocation; excessive tearing; thrombophlebitis (IV).

 Precautions

Pregnancy: Category C (parenteral). Lactation: Do not use in nursing women. Children: Safety in children < 5 yr not established. Special risk patients: Use drug with caution in patients with impaired pulmonary function (especially COPD) or cardiac function. Hepatic effects: Fatal and nonfatal liver disorders may occur; use drug with caution in patients with pre-existing hepatic impairment and in females and patients > 35 yr. Long-term use: 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. Malignant hyperthermia: Supportive care should be foremost in treatment (ie, concurrent with dantrolene therapy). Extravasation: Because of the high pH of the IV formulation, prevent extravasation into the surrounding tissue. IV Dantrolene: IV dantrolene is also associated with the loss of grip strength and weakness in the legs.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • 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 until solution is clear.
  • Store at room temperature for up to 6 hr. Protect from direct light.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess neuromuscular status before and during therapy.
  • Assess family’s anesthesia history. Ask specifically about crises or deaths in operating room.
  • Assess for constipation, and auscultate bowel sounds regularly.
  • Encourage patient to increase fluid and fiber intake during therapy.
  • Keep emergency equipment nearby to treat respiratory depression.
  • Measure and document intake and output.
  • Monitor infusion site regularly for potential complications.
  • If weakness or dizziness develops, keep side rails up and supervise ambulation.
  • If difficulty swallowing develops, implement safety precautions with meals and medications.

 Patient/Family Education

  • 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 patient to report these symptoms to physician: weakness, malaise, fatigue, nausea, diarrhea, skin rash, itching, bloody or black tarry stools or 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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