NIMBEX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for NIMBEX (NIMBEX).
Competitive antagonist at nicotinic acetylcholine receptors at the neuromuscular junction, blocking neurotransmission and inducing muscle relaxation.
| Metabolism | Hofmann elimination (non-enzymatic degradation at physiological pH and temperature) with minor ester hydrolysis; independent of hepatic or renal function. |
| Excretion | Primarily renal (80% as unchanged drug and metabolites); biliary/fecal excretion accounts for <20%. |
| Half-life | Terminal elimination half-life approximately 20-30 minutes in healthy adults; prolonged in hepatic or renal impairment. |
| Protein binding | Approximately 60-70% bound to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | Steady-state volume of distribution (Vdss) approximately 0.2-0.3 L/kg, indicating distribution primarily in extracellular fluid. |
| Bioavailability | Not applicable; administered intravenously only. |
| Onset of Action | Intravenous: 1-2 minutes for intubating doses (0.15-0.2 mg/kg). |
| Duration of Action | Clinical duration (time to 25% recovery of T1): 25-40 minutes after intubating dose; context-sensitive half-time increases with infusion duration. |
0.15-0.2 mg/kg IV bolus for intubation; maintenance infusion 1-2 mcg/kg/min (initial) adjusted to effect.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment for GFR reductions, but prolonged recovery may occur; consider using train-of-four monitoring. |
| Liver impairment | Child-Pugh class A/B: no adjustment; Child-Pugh class C: reduce initial dose by 30-50% due to prolonged duration of action. |
| Pediatric use | Infants 2-12 months: 0.15 mg/kg IV bolus; children 1-12 years: 0.1-0.15 mg/kg IV bolus; maintenance infusion 1-2 mcg/kg/min titrated to effect. |
| Geriatric use | Elderly may have slower onset and prolonged recovery; use lower initial doses (0.1-0.15 mg/kg IV bolus) and titrate infusion carefully with neuromuscular monitoring. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for NIMBEX (NIMBEX).
| Breastfeeding | Not known if excreted in human milk; M/P ratio not determined. Consider risks of infant exposure; caution advised. Use only if potential benefit outweighs risk. |
| Teratogenic Risk | Category B. No evidence of teratogenicity in animal studies; no adequate human studies in first trimester. Risk of neonatal apnea and bradycardia if used near delivery due to placental transfer. Use only if clearly needed. |
| Fetal Monitoring |
■ FDA Black Box Warning
None. NIMBEX (cisatracurium) does not have an FDA black box warning.
| Serious Effects |
["Known hypersensitivity to cisatracurium or any component of the formulation","History of anaphylaxis to any neuromuscular blocking agent"]
| Precautions | ["Must be administered by trained personnel familiar with neuromuscular blockade and resuscitation equipment","Risk of anaphylaxis and histamine release (though rare with cisatracurium)","Monitor neuromuscular transmission with a nerve stimulator to avoid prolonged blockade","May cause bradycardia if combined with vagolytic or opioid agents","Use caution in patients with neuromuscular diseases (e.g., myasthenia gravis) as sensitivity may be altered","Acid-base or electrolyte abnormalities may potentiate or antagonize effects","Do not mix with alkaline solutions (e.g., thiopental) as inactivation occurs"] |
Loading safety data…
| Monitor maternal vital signs, oxygen saturation, and neuromuscular transmission continuously. Observe neonate for signs of neuromuscular blockade (weakness, apnea) after delivery. |
| Fertility Effects | No known effects on human fertility. Animal studies not reported to show impairment. |