Cisatracurium bezylate (Cisatracurium besilate)

Composition Pharmacodynamics Indications Carefully Contraindications Dosing and Administration Side effects Form release / dosage
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Active substanceCisatracurium bezylateCisatracurium bezylate
Dosage form: & nbspRAsterol for intravenous administration.
Composition:Per 1 ml:

Active substance:

Cisatracurium bezylate

2,68 mg

in terms of cisatracurium

2,00 mg

Excipients:

32% w / v. benzene sulfonic acid solution

before pH 3,0-3,8

Water for injections

before 1 ml
Description:

Prose, from colorless to light yellow or greenish-yellow liquid.

Pharmacotherapeutic group:muscle relaxant, non-depolarizing of peripheral action
ATX: & nbsp

M.03.A.C.11   Cisatracurium bezylate

Pharmacodynamics:

Mechanism of action

Cisatracurium bezylate is a nondepolarizing muscle relaxant of the average duration of action of the benzylisoquinoline group.

Pharmacodynamics

Clinical studies on men have shown that cisatracurium bezylate in a dose, up to 8 times higher than necessary for 95% suppression of the reaction of the abductor muscle of the big finger in response to stimulation of the ulnar nerve (ED95), does not cause a dose-dependent release of histamine.

Cisatracurium bezylate, by binding to n-holinoretseptorami motor nerves, acts as an antagonist of acetylcholine, leading to a competitive blockade of neuromuscular conduction.Its effect is reversible upon the administration of anticholinesterase agents, such as neostigmine methylsulfate and eudrophonia chloride. ED95 cisatracurium bezilate during opioid anesthesia (fentanyl, thiopental sodium, and midazolam) is 0.05 mg / kg.

ED95 Cisatracurium besylate in children during halothane anesthesia is 0.04 mg / kg.
Pharmacokinetics:

The pharmacokinetics of cisatracurium bezylate (non-compartmental model) does not depend on the dose in the range from 0.1 to 0.2 mg / kg (ie from 2 to 4 x ED95) Population pharmacokinetic modeling confirms and extends this range to 0,4 mg / kg (8 x ED95).

Distribution

After intravenous doses of 0.1 and 0.2 mg / kg of cisatracurium bezilate to adult surgical patients, the volume of distribution in the equilibrium state is from 121 up to 161 mg / kg.

Metabolism

At physiological pH and body temperature Cisatracurium bezylate spontaneously breaks down in the body (elimination of Hofmann) with the formation of laudanosine and monochetvertic acrylate metabolite, which in turn undergoes hydrolysis under the action of nonspecific plasma esterase to the mono-quaternary metabolite of alcohol.Metabolites do not have muscle relaxant properties.

Excretion

Excretion of cisatracurium bezilate is mainly organ-independent, and excretion through the liver and kidneys is the primary way of eliminating its metabolites.

Pharmacokinetics for infusion and bolus administration

Pharmacokinetic parameters of the preparation Cisatracurium bezylate, administered in the form of bolus injections in doses higher 0,1 and 0,2 mg / kg to adult surgical patients are presented in the table.

The mean values ​​of the pharmacokinetics data corresponding to the limits of the average doses of cisatracurium bezylate

Parameter

Limits of average values

Clearance

4.7-5.7 ml / min / kg

The volume of distribution in the equilibrium state

121-161 ml / kg

The half-life (T1/2)

22-29 min

The pharmacokinetics of cisatracurium bezylate after intravenous drip or jet administration is the same. The average clearance of cisatracurium bezylate is 6.9 ml / kg / min, a T1/2 - 28 min. The removal of the drug does not depend on the duration of the infusion and does not differ from that for its bolus administration.

Special patient groups

Elderly patients

There is no clinically significant difference in the pharmacokinetics of cisatracurium bezilate in patients of young and elderly age, its clearance is independent of age.A slight increase in the volume of distribution (+ 17%) and T1/2 (+4 min) does not affect the recovery time of neuromuscular conduction in elderly patients.

Patients with impaired renal function

A clinically significant difference in the pharmacokinetics of cisatracurium bezilate in patients with terminal stage of renal failure and in healthy volunteers is not observed. According to the comparative study, there were no statistically significant or clinically significant differences in the pharmacokinetic parameters of cisatracurium bezylate. The recovery time of neuromuscular conduction also does not change with renal failure.

Patients with impaired hepatic function

Clinically significant differences in the pharmacokinetics of cisatracurium bezilate in patients with the thermal stage of hepatic insufficiency and in healthy volunteers do not. In a comparative study of patients who showed liver transplantation and healthy volunteers, a slight difference in the volume of distribution (+21%) and clearance (+ 16%) of cisatracurium bezylate, but T1/2 and the recovery time of neuromuscular conduction did not change.

Patients of intensive care units (ICU)

The pharmacokinetics of cisatracurium bezilate in patients in ICU receiving it in the form of prolonged infusion or jet infusion is not different, and there is no difference from that in healthy adults. The average clearance of cisatracurium bezylate is 7.5 ml / kg / min, and T1/2 is 27 minutes. Pharmacokinetics of the drug with prolonged infusion introduction does not depend on the duration of infusion. The concentration of metabolites in the blood plasma is higher in those patients in the ICU who have impaired renal and / or liver function. However, these metabolites do not affect neuromuscular blockade.

Indications:

Cisatracurium bezylate is used for myoplegia as a supplement to general anesthesia or sedation, for intubation of the trachea and artificial ventilation (IVL) for surgical operations and other surgical interventions, as well as in the ICU.

Contraindications:

Hypersensitivity to cisatracurium bezilate, atracurium bezilate, benzenesulfonic acid and other derivatives of bis-benzylisoquinolines.

Carefully:

It should be used with caution in the event of a violation of acid-base balance and electrolyte balance; carcinomatosis or neuromuscular diseases (including myasthenia gravis gravis and myasthenic syndrome) or other conditions that can lead to prolonged neuromuscular blockade; burns; hemiparesis or paraparesis.

Pregnancy and lactation:

Fertility

Influence on reproductive function has not been studied.

Pregnancy

A drug Cisatracurium bezylate It should be used during pregnancy only if the expected benefit to the mother exceeds the potential risk to the fetus.

Teratogenicity

Studies in animals have shown that cisatracurium bezylate does not have teratogenic and toxic effects on the fetus.

Breastfeeding period

It is not known whether cisatracurium bezylate or its metabolites with human breast milk. A drug Cisatracurium bezylate should be used during breastfeeding only if the expected benefit for the mother exceeds the potential risk for the child.

Dosing and Administration:

A drug Cisatracurium bezylate, the solution for intravenous administration does not contain antimicrobial preservatives and is intended for administration to one patient.

Bolus intravenous (iv)

Adults

Intubation of the trachea

The recommended dose of Cisatracurium besylate for intubation of the trachea in adults is 0.15 mg / kg, which is administered within 5-10 seconds and provides optimal conditions for intubation of the trachea during 120 s after injection.

With the introduction of higher doses of the drug, neuromuscular blockade occurs more quickly. The table shows the average pharmacodynamic indices of cisatracurium bezylate when administered at doses of 0.1 to 0.4 mg / kg to healthy adult volunteers against opioid anesthesia (thiopental sodium, fentanyl and midazolam) or anesthesia with propofol.

The mean values ​​of the data on pharmacodynamics within the limits of the average doses of cisatracurium bezylate

Initial dose of cisatracurium bezylate for intravenous administration, mg / kg

Type of anesthesin

Time to 90% suppression of T1 *), min

Time before the maximum suppression T1 *), min

Time to 25% spontaneous recovery of T1 *), min

0,1

Opioid

3,4

4,8

45

0,15

Propofol

2,6

3,5

55

0,2

Opioid

2,4

2,9

65

0,4

Opioid

1,5

1,9

91

*)T1 is a single contraction of the muscle that leads the thumb of the hand, as well as its first contraction in response to a series of four pulses with supramaximal electrical stimulation of the ulnar nerve.

Enflurane or isoflurane can extend the duration of the blockade caused by the initial dose of the drug by 15% Cisatracurium bezylate.

Maintenance dose

The duration of neuromuscular blockade can be increased by the introduction of maintenance doses of Cisatracurium bezilate. Thus, during anesthesia with opioids or propofol cisatracurium bezylate in a dose of 0.03 mg / kg prolongs the neuromuscular blockade by approximately 20 minutes. However, the subsequent administration of maintenance doses does not lead to a progressive lengthening of the blockade.

Spontaneous recovery

After the spontaneous recovery of neuromuscular conduction has begun, its rate does not depend on the administered dose of Cisatracurium bezilate. During anesthesia with opioids or propofol, the mean recovery time for neuromuscular conduction from 25% to 75% and from 5% to 95% is approximately 13 minutes and 30 minutes, respectively.

Reversibility

Cisatracuria induced by bezelate neuromuscular blockade is easily eliminated by standard doses of cholinesterase inhibitors. After the introduction of cholinesterase inhibitor on average with a 10% T1 reduction in conductivity, the average conduction recovery time from 25% to 75% and until complete recovery (T4: T1 ≥ 0.7) is approximately 4 minutes and 9 minutes, respectively.

Children aged 1 month to 12 years

Intubation of the trachea

As in adults, the initial dose of Cisatracuria besylate for intubation of the trachea in children is 0.15 mg / kg, which is given intravenously for 5-10 seconds and creates optimal conditions for intubation of the trachea within 120 seconds after the injection. The pharmacodynamic data for these doses are presented in the tables below. Based on pharmacodynamic data to provide a neuromuscular blockade of a shorter duration, the initial dose of Cisatracurium bezilate 0.1 mg / kg is recommended; in this case, similar conditions for intubation of the trachea are created at 120-150 s after the administration of the drug. Possibility of using Cisatracuria besylate for intubation in children with a class III-IV by ASA not studied.

Data on the use of cisatracurium bezilate in children younger 2 years in the conduct of long or large operations are limited.

The duration of neuromuscular blockade against a background of Cisatracurium bezilate in children aged from 1 months. before 12 years decrease, and its spontaneous recovery occurs faster in comparison with adults with the same type of anesthesia. There are insignificant differences in pharmacodynamic parameters of cisatracurium bezilate in children aged 1 before 11 months. from those in children aged from 1 before 12 years.

Pharmacodynamic parameters cisatracurium bezylate for children aged 1 to 11 months. and from 1 years before 12 years are presented in the tables.

Children aged from 1 to 11 months.

Initial dose of cisatracurium bezylate for intravenous administration, mg / kg

Type of anesthesia

Time

the onset of 90% suppression of T1, min

Time before maximum suppression T1, min

Time to 25% spontaneous recovery T1, min

0,15

Halothane

1,4

2,0

52

0,15

Opioid

1,4

1,9

47

Children aged 1 to 12 years

Initial dose of cisatracurium bezylate for intravenous administration, mg / kg

Type of anesthesia

Time of onset of 90% suppression of T1, min

Time before maximum suppression T1, min

Time to 25% spontaneous recovery T1, min

0,15

Halothane

2,3

3,0

43

0,15

Opioid

2,6

3,6

38

When using Tsisatrakuria besylate, doses less than 0.15 mg / kg may not be used for intubation. Pharmacodynamic parameters for doses of 0.08 and 0.1 mg / kg in children aged 2 to 12 years are presented in the table below.

Children from 2 to 12 years old

Initial dose of cisatracurium bezylate for intravenous administration, mg / kg

Type of anesthesin

Time of onset of 90% suppression of T1, min

Time before maximum suppression T1, min

Time to 25% spontaneous recovery T1, min

0,08

Halothane

1,7

2,5

31

0,1

Opioid

1,7

2,8

28

Halothane may prolong the duration of the neuromuscular blockade caused by cisatracurium bezylate by no more than 20%. Information on the use of cisatracurium bezilate in children during anesthesia with isoflurane or enflurane is not available, but it can be expected that these inhaled anesthetics can also increase the duration of neuromuscular blockade caused by the drug by no more than 20%.

Supportive dose (children aged 2 to 12 years)

The duration of neuromuscular blockade can be increased by the introduction of cisatracurium bezylate in maintenance doses. With halothane anesthesia, cisatracurium bezylate in a dose 0,02 mg / kg increases the duration of neuromuscular blockade by approximately 9 minutes. However, the subsequent administration of maintenance doses does not lead to a progressive lengthening of the blockade.

The data is not enough to give specific recommendations but the selection of a maintenance dose in children aged 2 years. However, very limited data from clinical trials in children before 2 years show that a maintenance dose of 0.03 mg / kg can prolong the clinically effective neuromuscular blockade up to 25 min with opioid anesthesia.

Spontaneous recovery

After the spontaneous recovery of neuromuscular conduction has begun, its rate does not depend on the administration of the dose of the drug Cisatracurium bezylate. During anesthesia with opioids or halothane, the mean recovery time of conductivity from 25% to 75% and from 5% to 95% is approximately 11 minutes and 28 minutes, respectively.

Reversibility

Cisatracurium-induced bezelate neuromuscular blockade is easily eliminated by standard doses of cholinesterase inhibitors. The average conduction recovery time from 25% to 75% and until complete recovery (T4 coefficient: T1 ≥ 0.7) after the administration of cholinesterase inhibitor, on average at 13%, T1 conduction recovery is approximately 2 min and 5 min, respectively.

Infusion introduction

Adults and children aged 2 months to 12 years

To maintain neuromuscular blockade Cisatracurium bezylate can be administered intravenously drip. To restore the blockade of T1 at 89-99% after the appearance of signs of spontaneous recovery of neuromuscular conduction, an initial infusion rate of 3 μg / kg / min (0.18 mg / kg / h) is recommended. After the initial stabilization of the neuromuscular blockade to maintain it at this level, the majority of patients have sufficient infusion rate within 1-2 μg / kg / min (0.06-0.12 mg / kg / h).

During anesthesia with isoflurane or enflurane, a decrease in the rate of infusion of Cisatracurium bezilate by 40% may be required.

The rate of infusion depends on the concentration of cisatracurium bezylate in the infusion solution, the required depth of the neuromuscular blockade and the patient's body weight.

The table contains recommendations for the introduction of undiluted Cisatracurium bezylate solution for intravenous administration, 2 mg / ml.

Infusion rate of Cisatracuria bezilate, solution for iv administration 2 mg / ml

see Fig. 1.

Continuous infusion Cisatracuria bezilata with a constant speed is not accompanied by a progressive increase or weakening of the neuromuscular blockade.

After cessaturation of the infusion of cisatracuria bezilata, the spontaneous recovery of neuromuscular conduction occurs at a rate comparable to that after a single bolus administration of the drug.

Despite the fact that the introduction of Cisatracuria besylate in the form of infusion was not specifically studied in children under the age of 2 years, by analogy with doses for bolus administration, it can be assumed that the infusion rate in this age group should be the same as in older children.

Special patient groups

Newborns under the age of 1 month.

There is no data on the use of cisatracurium bezilate in children under 1 month of age, therefore, it is not possible to give recommendations on the dosage of the drug in this age group. Elderly patients

Dose adjustments in elderly patients are not required. Pharmacodynamics of cisatracurium besylate in them is similar to that of young patients, but the effect of Cisatracurium bezilate, like other muscle relaxants, may begin somewhat later.

Patients with impaired renal function

Dose adjustments in patients with renal insufficiency are not required. Pharmacodynamics of cisatracurium besylate in them is similar to that of patients with a normal function of the nights, but the effect of Cisatracurium bezilate may begin somewhat later.

Patients with impaired hepatic function

Dose adjustments in patients with terminal liver failure are not required. Pharmacodynamics of cisatracurium besylate in them is similar to that in patients with normal liver function, however, the effect of Cisatracurium bezilate may begin somewhat earlier.

Patients with diseases of the cardiovascular system

The rapid administration of cisatracurium bezilate (within 5-10 s) as a bolus in any studied dose (up to 0.4 mg / kg inclusive - 8 x ED95) to patients with severe cardiovascular diseases (I-III functional class for NYHA, subjected to aortocoronary shunting) is not accompanied by clinically significant reactions from the cardiovascular system.

Data on the use of Cisatracuria besylate in children undergoing cardiosurgery are not available.

Application in ICU

Adult patients in the ICU drug Cisatracurium bezylate can be injected intravenously (as a bolus) and / or drip (as an infusion).

For adult patients in ICU, the recommended initial infusion rate of Cisatracuria bezilate is 3 μg / kg / min (0.18 mg / kg / h). In different patients, the dose required varies over a wide range and may, with time, increase or decrease. In clinical studies, the average infusion rate was 3 μg / kg / min (0.5-10.2 μg / kg / min or 0.03-0.6 mg / kg / h).

The mean time to complete spontaneous recovery of conductivity after a prolonged (up to 6 days) infusion of Cisatracuria besylate in patients in ICU is approximately 50 min.

The rate of recovery of neuromuscular conduction after completion of infusion of Cisatracuria besylate in patients in ICU does not depend on its duration.

Use in patients undergoing cardiac surgery under hypothermia

There is no data on the use of the drug Cisatracurium bezylate during cardiac surgery under hypothermia (25-28 ° C). As with other muscle relaxants, the rate of infusion necessary to maintain adequate surgical muscle relaxation under these conditions is expected to be significantly reduced.

Monitoring

As with other muscle relaxants, when using Tsisatrakurium besylate for individual dosing, monitoring of neuromuscular function is recommended.

Instructions for use of the solution

Since the preparation does not contain antimicrobial preservatives, it should be diluted immediately before use, the diluted solution must be injected immediately, and the unused drug solution should be disposed of. Cisatracurium bezylate is chemically unstable when diluted in Ringer's solution.

With the introduction of other drugs through the same needle or cannula through which Cisatracuria bezilate was administered, it is recommended that the needle and cannula be washed with a sufficient amount of a compatible solution for intravenous administration, for example with a solution of 0.9% sodium chloride.

Cisatracurium bezylate is stable only in acidic solutions, therefore it should not be mixed in one syringe or administered simultaneously through a single needle with alkaline solutions, for example, with sodium thiopental.

If a peripheral vein of small caliber is used for the administration of Cisatracuria besylate, after administration, it should be washed with a compatible solution for intravenous administration, for example with a solution of 0.9% sodium chloride.

Side effects:

The incidence of adverse events following the use of the drug is classified according to WHO recommendations: very often (≥1 / 10), often (≥1 / 100 and <1/10), infrequently (≥1/1000 and <1/100), rarely (≥1/10000 and <1/1000), very rarely (<1/10000, including individual cases).

From the immune system: Very rarely - anaphylactic reactions (may vary in severity and severity after the administration of muscle relaxants).

From the side of the cardiovascular system: often - a bradycardia, decrease blood pressure; infrequent - redness of the skin.

From the respiratory system: infrequently - bronchospasm.

From the side of the musculoskeletal system: very rarely - myopathy, muscle weakness (several cases were registered against the background of prolonged use of muscle relaxants in severe patients in ICU, most of whom received concomitant therapy with corticosteroids.) The causal relationship with the introduction of cisatracurium bezelag in these cases has not been established.

From the skin: infrequent - rash.

Overdose:

Symptoms: the main symptoms of an overdose of Cisatracuria besylate are prolonged paralysis of the muscles, including the respiratory ones, and its consequences.

Treatment: before the recovery of adequate spontaneous breathing is very important maintain ventilation and oxygenation of the blood. Complete sedation is necessary, since Cisatracurium bezylate does not affect consciousness. When signs of spontaneous recovery of neuromuscular conduction appear, it can be accelerated with cholinesterase inhibitors.

The administration of 0,04-0,7 mg / kg of neostigmine methyl sulfate at a 10% reduction in conductivity provides 95% recovery (T4: T1 ≥ 0.7) on average for 9 to 10 minutes. Conductivity recovery time from 25% until complete recovery (the ratio of T4: T1 ≥ 0.7) with the application of the indicated doses neostigmine methylsulfate reaches 7 minutes. The average recovery index from 25% to 75% is from 3 to 4 minutes.

Administration of eudrophonia chloride at a dose of 1.0 mg / kg at approximately 25% reduction of the neuromuscular block (16-30%) provides 95% recovery (T4: T1 ≥ 0.7) on average 3-5 min.

Interaction:

Many drugs affect the severity and / or duration of action of nondepolarizing muscle relaxants.

Strengthen the effect of muscle relaxants:

- funds for general anesthesia:

- other drugs:

In rare cases, some drugs may worsen the course or contribute to the manifestation of a latent myasthenia gravis gravis, cause myasthenic syndrome, as a result, there may be increased sensitivity to nondepolarizing muscle relaxants. These drugs include various antibiotics, beta-adrenoreceptor blockers (propranolol, oxprenolol), antiarrhythmic drugs (procainamide, quinidine), antirheumatic drugs (chloroquine, penicillamine), trimetaphane camsylate, chlorpromazine, steroids, phenytoin and lithium salts.

The introduction of suxamethonium in order to increase the duration of neuromuscular blockade can lead to a prolonged complex blockade, which can be difficult to eliminate with the help of cholinesterase inhibitors.

Weaken the effect of muscle relaxants:

- previous long-term use of phenytoin or carbamazepine;

- therapy with cholinesterase inhibitors, often used to treat Alzheimer's disease, such as donepezil, can shorten the duration of neuromuscular blockade and weaken the muscle relaxant effect of cisatracurium bezylate.

Do not affect:

- the preliminary administration of suxamethonium does not affect the duration of the neuromuscular blockade caused by the bolus administration of Cisatracurium bezilate and should not be taken into account when choosing the infusion rate of the drug;

When administered under conditions simulating an infusion system with a Y-shaped catheter, Cisatracurium bezylate is compatible with the following drugs commonly used during surgery: alfentanil, droperidol, fentanyl, midazolam and sufentanil.

The drug is not compatible with ketorolac trometamol and propofol emulsion for IV administration.

Special instructions:

Cisatracurium bezylate causes paralysis of the respiratory and skeletal muscles, but does not affect the consciousness and threshold of pain sensitivity. The drug should appoint an anesthetist or a doctor of other specialties who have experience using muscle relaxants. It is necessary to ensure the availability and availability of equipment for intubation of the trachea, maintenance of pulmonary ventilation and adequate oxygen saturation of blood.

With the appointment of muscle relaxants, including cisatracurium bezilate, it is necessary to observe the neuromuscular conduction in order to select an individual dose of the drug.

Given the possibility of cross-allergic reactions between muscle relaxants, special care should be taken when using cisatracurium bezilate in patients who have hypersensitivity reactions to other muscle relaxants, since more than 50% of them show cross-reactions of hypersensitivity.

Cisatracuria bezylate does not have pronounced m-cholin-blocking or ganglion-blocking properties, so it has no clinically significant effect on the heart rate (does not increase bradycardia caused by many agents for anesthesia or irritation of the vagus nerve during surgery).

In patients with myasthenia gravis gravis and other forms of neuromuscular disease significantly increased sensitivity to nondepolarizing muscle relaxants. The recommended initial dose of cisatracurium bezylate in these patients should not exceed 0,02 mg / kg.

Severe disturbances of acid-base balance and / or electrolyte metabolism can change (increase or decrease) the sensitivity of patients to muscle relaxants.

The effect of cisatracurium bezilate in patients with malignant hyperthermia in history was not studied.Studies conducted on animals (pigs) susceptible to malignant hyperthermia have shown that cisatracurium bezylate does not cause this syndrome.

Patients who undergo surgery with induced hypothermia

There were no studies of Cisatracuria bezilate in patients with operations with induced hypothermia (25 to 28 ° C). As with other muscle relaxants, the infusion rate necessary to maintain adequate surgical muscle relaxation in these conditions is expected to be significantly reduced.

The effect of cisatracurium bezilate in patients with burns was also not studied. However, when assigning such patients Cisatracuria besylate, as well as other nondepolarizing muscle relaxants, it must be borne in mind that a large dose of the drug may be required, and the duration of its action may be less.

The prepared solution of Cisatracurium bezylate is hypotonic and should not be introduced into the infusion system through which blood transfusion is performed.

In patients with hemi and paraparesis, injuries to the lower extremities may result in resistance to the action of nondepolarizing muscle relaxants.For proper selection of the dose, it is necessary to monitor the expression of the neuromuscular block on the unaffected limb.

Patients in ICU

Administration of laudanosine to animals (metabolite of cisatracurium bezilate and atracurium bezilate) in high doses was accompanied by a transient decrease in arterial pressure and, in some cases, symptoms of excitation of the cerebral cortex. In the most sensitive animal species, there were reactions to laudanosine at concentrations that are achieved in patients in ICU after prolonged infusion of cisatracurium or atracuria.

There are some reports of seizures in patients in ICU who received atracurium bezylate in combination with other drugs. Since they usually suffered from diseases that predisposed to the appearance of seizures (for example, traumatic brain injury, hypoxic encephalopathy, cerebral edema, viral encephalitis, uremia), the cause-and-effect relationship between seizures and laudanosin was not established.

It should be borne in mind that the concentration of laudanosine in blood plasma when administered cisatracurium bezylate approximately 3 times less than with infusion of atracurium besylate.

Effect on the ability to drive transp. cf. and fur:

Cisatracurium bezylate is always used during anesthesia, therefore, the effect on the ability to drive a car or other moving mechanisms will be the same as for drugs for anesthesia.

If after the application of Cisatracuria bezilat an early discharge is provided, patients should not drive vehicles or operate machinery.

Form release / dosage:

Solution for intravenous administration, 2 mg / ml.

Packaging:

By 2.5 ml, 5 ml or 10 ml into neutral glass ampoules. 5 ampoules per contour cell packaging made of polyvinyl chloride film.

For 1 or 2 contour squares with a vial for opening ampoules or a scarifier ampoule and instructions for use in a pack of cardboard.

When you pack the ampoules with a break ring or break point, the ampoule opener or ampoule scapper is not put in.

Storage conditions:

In the dark place at a temperature of 2 to 8 ° C. Do not freeze.

Keep out of the reach of children.

Shelf life:

2 years.

Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription
Registration number:LP-003973
Date of registration:21.11.2016
Expiration Date:21.11.2021
The owner of the registration certificate:OBNINSKAYA CHEMICAL - PHARMACEUTICAL COMPANY, CJSC OBNINSKAYA CHEMICAL - PHARMACEUTICAL COMPANY, CJSC Russia
Manufacturer: & nbsp
Information update date: & nbsp14.12.2016
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