AHFS Class:

12:20.20 Neuromuscular Blocking Agents

Generic Name

• Cisatracurium Besylate (CAS Registry Number: 96946-42-8)

Cisatracurium besylate is available as a 2-mg/mL injection solution in 5-mL single-dose vials and 10-mL multiple-dose vials, and also as a 10-mg/mL injection solution in 20-mL single-dose vials.²⁸⁶⁸ Each mL contains cisatracurium 2 or 10 mg (equivalent to 2.68 or 13.38 mg of cisatracurium besylate, respectively) with benzenesulfonic acid for pH adjustment.²⁸⁶⁸ Multiple-dose vials also contain benzyl alcohol 0.9% (w/v) as a preservative.²⁸⁶⁸

pH

3 to 3.8.²⁸⁶⁸

Trade Name(s)

Nimbex

Cisatracurium besylate is administered intravenously only.²⁸⁶⁸ Both initial bolus doses and continuous intravenous infusion have been used.²⁸⁶⁸ Rates of administration depend on the drug concentration in the solution, desired dose, and patient weight.²⁸⁶⁸ Avoid contact with alkaline drugs during administration.²⁸⁶⁸

Cisatracurium besylate injection is a colorless to slightly yellow or greenish-yellow solution.²⁸⁶⁸ Intact vials should be stored at 2 to 8°C protected from light and freezing.²⁸⁶⁸ The manufacturer recommends that intact vials that have been removed from refrigeration and exposed to controlled room temperature conditions be used within 21 days even if rerefrigerated.²⁸⁶⁸

In an independent study, cisatracurium besylate at cisatracurium concentrations of 2 mg/mL in 5- and 10-mL vials and 10 mg/mL in 20-mL vials was stored at 4 and 23°C both protected from light and exposed to fluorescent light. All the samples remained physically stable throughout the 90-day study period. Samples stored under refrigeration exhibited little or no drug loss in 90 days whether exposed to or protected from light. At 23°C, samples were stable through 45 days of storage with losses near 5 to 7% in most samples. However, most samples became unacceptable after 90 days of storage at 23°C, exhibiting losses of 9 to 14%.²¹¹⁶

pH Effects

The manufacturer indicates that cisatracurium besylate may not be compatible with barbiturates and other alkaline solutions having a pH greater than 8.5.²⁸⁶⁸

Syringes

In 2015, reports of decreased potency of certain drugs (e.g., cisatracurium besylate) stored in Becton Dickinson syringes for extended periods (i.e., exceeding 24 hours) were confirmed by the manufacturer of these syringes; the cause of this change was later identified to be the inclusion of an alternate rubber stopper in the plunger of certain product lots of syringes.³⁰²⁹; ³⁰³⁶; ³⁰³⁷; ³⁰³⁹; ³⁰⁴¹; ³⁰⁴² Decreased potency was not observed when the syringes were filled and used promptly.³⁰³⁷ Use of the alternate stopper was later discontinued and use of the primary stopper in such syringes was resumed; however, Becton Dickinson states that its general-use syringes are cleared by FDA for immediate use in fluid aspiration and injection and that such syringes, regardless of the stopper material, have not been cleared by FDA for use as a closed-container system.³³⁹¹

Cisatracurium besylate at a cisatracurium concentration of 2 mg/mL was repackaged in 3-mL plastic syringes (Becton Dickinson) and sealed with tip caps (Red Cap, Burron). The syringes were stored at 4 and 23°C both protected from light and exposed to fluorescent light. All of the samples remained physically stable throughout the 30-day study period. Little or no loss occurred when stored under refrigeration, whereas samples stored at 23°C exhibited 4 to 7% loss in 30 days.²¹¹⁶

Standardize 4 Safety

One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.

Table 1. Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Cisatracurium³⁶³⁵; ³⁶³⁶

^aParalytics are recommended to be administered as straight drug. This provides consistency between operating room and the ICU, and eliminates potential compounding errors.^bThis is a concentration that differs from the package insert, therefore infusion-related calculations will differ from the prescribing information.

Solution Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions December 20, 2025. © Copyright, 2025. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.