dantrolene

ROUTE	ONSET	PEAK	DURATION
PO	1 wk	unknown	6–12 hr
IV	rapid	rapid	unknown

Because of the potential risk of hepatotoxicity with long-term use, dantrolene therapy should be discontinued if benefits are not evident within 45 days.

Spasticity

PO (Adults ): 25 mg once daily for 7 days; then 25 mg twice daily for 7 days; then 50 mg 3 times daily for 7 days; then 100 mg 3 times daily; may ↑ to 100 mg 4 times daily, if needed.
PO (Children ≥5 yr): 0.5 mg/kg once daily for 7 days; then 0.5 mg/kg 3 times daily for 7 days; then 1 mg/kg 3 times daily for 7 days; then 2 mg/kg 3 times daily (not to exceed 400 mg/day).

Prevention of Malignant Hyperthermia

PO (Adults and Children ≥5 yr): 4–8 mg/kg/day in 3–4 divided doses for 1–2 days before procedure, with last dose 3–4 hr preoperatively.
IV (Adults and Children ): 2.5 mg/kg given 75 min before surgery.

Treatment of Malignant Hyperthermia

IV (Adults and Children ): At least 1 mg/kg, continued until symptoms ↓ or a cumulative dose of 10 mg/kg has been given. If symptoms reappear, dose may be repeated.

Neuroleptic Malignant Syndrome (unlabeled)

IV (Adults ): 1–2.5 mg/kg initially; if rapid resolution of hyperthermia and rigidity is observed, may follow with 1 mg/kg every 6 hr (max dose = 10 mg/kg/day). After the patient is stabilized and symptoms have resolved, consider taper over days to wks; do not abruptly discontinue.

Availability ⬆ ⬇

(Generic available)

Capsules: 25 mg; 50 mg; 100 mg
Powder for injection: 20 mg/vial; 250 mg/vial

Assessment ⬆ ⬇

Assess bowel function periodically. Persistent diarrhea may warrant discontinuation of therapy.
Muscle spasticity: Assess neuromuscular status and muscle spasticity before and periodically during therapy to determine response.
Malignant hyperthermia: Assess previous anesthesia history of all surgical patients. Also assess for family history of reactions to anesthesia (malignant hyperthermia or perioperative death).
- Monitor ECG, vital signs, electrolytes, ventilation, and urine output continuously when administering IV for malignant hyperthermia. Assess for a ↓ in body temperature and ↑ in muscle relaxation.
- Monitor patient for difficulty swallowing and choking during meals on the day of administration.

Lab Test Considerations:

Monitor liver function at baseline and frequently during therapy. Liver function abnormalities (↑ AST, ALT, alkaline phosphatase, bilirubin, GGT) may require discontinuation of therapy.
- Evaluate renal function and CBC before and periodically during therapy in patients receiving prolonged therapy.

Implementation ⬆ ⬇

PO: If gastric irritation becomes a problem, may be administered with food. Oral suspensions may be made by opening capsules and adding them to fruit juices or other liquids. Drink immediately after mixing.

IV Administration:

Reconstitution: Reconstitute each 20 mg of Dantrium with 60 mL of sterile water for injection (without a bacteriostatic agent). Shake until solution is clear. Solution must be used within 6 hr. Protect diluted solution from direct light.
- Reconstitution: Reconstitute Ryanodex by adding 5 mL of sterile water for injection; do not reconstitute with other solutions. Shake vial to ensure uniform orange suspension. Do not administer solutions that are discolored or contain particulate matter. Solution is stable for 6 hr at room temperature.

Treatment of Malignant Hyperthermia

IV Push: Administer reconstituted solution without further dilution.
Rate: Administer each single dose by rapid continuous IV push through Y-site. Follow immediately with subsequent doses as indicated. Medication is very irritating to tissues; observe infusion site frequently to avoid extravasation.

Prevention of Malignant Hyperthermia

IV Push: Rates of products for prevention differ.
Rate: Inject Ryanodex over ≥1 min starting 75 min before surgery into catheter with free-flowing 0.9% NaCl or D5W or into a patent indwelling catheter; flush before and after injection.
Intermittent Infusion: Reconstitute required number of Dantrium vials as above and transfer to a larger volume sterile plastic bag; do not use glass bottles.
Rate: Administer over 1 hr beginning 75 min before anesthesia.
Y-Site Compatibility:
- acyclovir
- paclitaxel
- palonosetron
Y-Site Incompatibility:
- alemtuzumab
- amikacin
- aminophylline
- amiodarone
- amphotericin B deoxycholate
- amphotericin B lipid complex
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azathioprine
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carmustine
- caspofungin
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- cisplatin
- clindamycin
- cyanocobalamin
- cyclosporine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin
- dexamethasone
- dexrazoxane
- diazepam
- diazoxide
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin liposomal
- doxycycline
- enalaprilat
- ephedrine
- epinephrine
- epoetin alfa
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- fluconazole
- fludarabine
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gemtuzumab ozogamicin
- gentamicin
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hetastarch
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- imipenem/cilastatin
- indomethacin
- insulin, regular
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- meperidine
- mesna
- methadone
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- minocycline
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- multivitamins
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- pamidronate
- pantoprazole
- papaverine
- pemetrexed
- penicillin G
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- phenytoin
- phytonadione
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propranolol
- protamine
- pyridoxine
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vinorelbine
- voriconazole
- zoledronic acid

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of dantrolene to patient. Advise patient not to take more medication than the amount prescribed to minimize risk of hepatotoxicity and other side effects. If a dose is missed, do not take unless remembered within 1 hr. Do not double doses. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
Emphasize the importance of follow-up exams to check progress in long-term therapy and blood tests to monitor for side effects.
May cause dizziness, drowsiness, visual disturbances, and muscle weakness. Advise patient to avoid driving and other activities requiring alertness until response to drug is known. After IV dose for surgery, patients may experience ↓ grip strength, leg weakness, light-headedness, and difficulty swallowing for up to 48 hr. Caution patients to avoid activities requiring alertness and to use caution when walking down stairs and eating during this period.
Instruct patient to notify health care provider if rash; itching; yellow eyes or skin; dark urine; or clay-colored, bloody, or black, tarry stools occur or if nausea, weakness, malaise, fatigue, or diarrhea persists. May require discontinuation of therapy.
Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications. Advise patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
Malignant hyperthermia: Patients with malignant hyperthemia should carry identification describing disease process at all times.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during therapy and for 3 days after last dose. Monitor infants breastfed during therapy for respiratory depression and muscle weakness.

Evaluation/Desired Outcomes ⬆ ⬇

Relief of muscle spasm in musculoskeletal conditions. ≥1 wk may be required to see improvement.
Prevention of or decrease in temperature and skeletal rigidity in malignant hyperthermia.

US Brand Names ⬆ ⬇

Dantrium, Revonto, Ryanodex

Code ⬆

NDC Code

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4411- Dantrolene Sodium
  - 0115-4411-01- 100 CAPSULE in 1 BOTTLE (0115-4411-01)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4411- Dantrolene Sodium
  - 0115-4411-02- 500 CAPSULE in 1 BOTTLE (0115-4411-02)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4411- Dantrolene Sodium
  - 0115-4411-03- 1000 CAPSULE in 1 BOTTLE (0115-4411-03)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4422- Dantrolene Sodium
  - 0115-4422-01- 100 CAPSULE in 1 BOTTLE (0115-4422-01)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4422- Dantrolene Sodium
  - 0115-4422-02- 500 CAPSULE in 1 BOTTLE (0115-4422-02)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4422- Dantrolene Sodium
  - 0115-4422-03- 1000 CAPSULE in 1 BOTTLE (0115-4422-03)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4433- Dantrolene Sodium
  - 0115-4433-01- 100 CAPSULE in 1 BOTTLE (0115-4433-01)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4433- Dantrolene Sodium
  - 0115-4433-02- 500 CAPSULE in 1 BOTTLE (0115-4433-02)

0115- Amneal Pharmaceuticals of New York LLC
- 0115-4433- Dantrolene Sodium
  - 0115-4433-03- 1000 CAPSULE in 1 BOTTLE (0115-4433-03)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9297- Dantrolene
  - 0143-9297-01- 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (0143-9297-01)

0904- Major Pharmaceuticals
- 0904-7211- Dantrolene Sodium
  - 0904-7211-04- 30 BLISTER PACK in 1 CARTON (0904-7211-04) / 1 CAPSULE in 1 BLISTER PACK

42023- ENDO USA, Inc.
- 42023-123- Dantrium
  - 42023-123-06- 6 VIAL in 1 CARTON (42023-123-06) / 60 mL in 1 VIAL

42023- Endo USA, Inc.
- 42023-124- Dantrium
  - 42023-124-01- 100 CAPSULE in 1 BOTTLE (42023-124-01)

42367- Eagle Pharmaceuticals, Inc.
- 42367-540- RYANODEX dantrolene sodium
  - 42367-540-32- 1 VIAL in 1 CARTON (42367-540-32) / 20 mL in 1 VIAL

49452- Spectrum Laboratory Products, Inc.
- 49452-2440-
  - 49452-2440-1- 25 g in 1 BOTTLE (49452-2440-1)

49452- Spectrum Laboratory Products, Inc.
- 49452-2440-
  - 49452-2440-2- 100 g in 1 BOTTLE (49452-2440-2)

49452- Spectrum Laboratory Products, Inc.
- 49452-2440-
  - 49452-2440-3- 500 g in 1 BOTTLE (49452-2440-3)

49452- Spectrum Laboratory Products, Inc.
- 49452-2440-
  49452-2440-4- 1000 g in 1 BOTTLE (49452-2440-4)

49884- Endo USA, Inc.
- 49884-362- dantrolene sodium
  49884-362-01- 100 CAPSULE in 1 BOTTLE (49884-362-01)

49884- Endo USA, Inc.
- 49884-363- dantrolene sodium
  - 49884-363-01- 100 CAPSULE in 1 BOTTLE (49884-363-01)

49884- Endo USA, Inc.
- 49884-364- dantrolene sodium
  - 49884-364-01- 100 CAPSULE in 1 BOTTLE (49884-364-01)

50268- AvPAK
- 50268-217- Dantrolene Sodium
  - 50268-217-15- 50 BLISTER PACK in 1 BOX (50268-217-15) / 1 CAPSULE in 1 BLISTER PACK (50268-217-11)

55154- Cardinal Health 107, LLC
- 55154-7140- Dantrolene Sodium
  - 55154-7140-0- 10 BLISTER PACK in 1 BAG (55154-7140-0) / 1 CAPSULE in 1 BLISTER PACK

55718- Isomedix Operations Inc
- 55718-105-
  - 55718-105-01- 1 VIAL in 1 CARTON (55718-105-01) / 20 mL in 1 VIAL

63629- Bryant Ranch Prepack
- 63629-2168- dantrolene sodium
  63629-2168-1- 100 CAPSULE in 1 BOTTLE (63629-2168-1)

63629- Bryant Ranch Prepack
- 63629-2169- dantrolene sodium
  - 63629-2169-1- 100 CAPSULE in 1 BOTTLE (63629-2169-1)

63629- Bryant Ranch Prepack
- 63629-2170- dantrolene sodium
  - 63629-2170-1- 100 CAPSULE in 1 BOTTLE (63629-2170-1)

64850- Elite Laboratories, Inc.
- 64850-840- Dantrolene Sodium
  - 64850-840-01- 100 CAPSULE in 1 BOTTLE (64850-840-01)

64850- Elite Laboratories, Inc.
- 64850-841- Dantrolene Sodium
  - 64850-841-01- 100 CAPSULE in 1 BOTTLE (64850-841-01)

64850- Elite Laboratories, Inc.
- 64850-842- Dantrolene Sodium
  - 64850-842-01- 100 CAPSULE in 1 BOTTLE (64850-842-01)

65129- ScinoPharm Taiwan Ltd.
- 65129-1012-
  - 65129-1012-0- 35 kg in 1 BAG (65129-1012-0)

67262- HAS Healthcare Advanced Synthesis SA
- 67262-2000-
  67262-2000-1- 4 kg in 1 DRUM (67262-2000-1)

68084- American Health Packaging
- 68084-300- Dantrolene Sodium
  68084-300-21- 30 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-300-21) / 1 CAPSULE in 1 BLISTER PACK (68084-300-11)

69575- Azico Biophore India Private Limited
- 69575-4036-
  - 69575-4036-2- 30 kg in 1 DRUM (69575-4036-2)

69988- Catalent Micron Technologies, Inc.
- 69988-0029-
  69988-0029-1- 1 BAG in 1 DRUM (69988-0029-1) / 25 POWDER in 1 BAG

71052- Darmerica, LLC
- 71052-508-
  71052-508-01- 1000 g in 1 CONTAINER (71052-508-01)

71052- Darmerica, LLC
- 71052-508-
  71052-508-05- 5000 g in 1 PACKAGE (71052-508-05)

71052- Darmerica, LLC
- 71052-508-
  71052-508-50- 500 g in 1 CONTAINER (71052-508-50)

71052- Darmerica, LLC
- 71052-508-
  71052-508-99- 25000 g in 1 CONTAINER (71052-508-99)

72162- Bryant Ranch Prepack
- 72162-1497- dantrolene sodium
  72162-1497-1- 100 CAPSULE in 1 BOTTLE (72162-1497-1)

72162- Bryant Ranch Prepack
- 72162-1498- dantrolene sodium
  - 72162-1498-1- 100 CAPSULE in 1 BOTTLE (72162-1498-1)

72162- Bryant Ranch Prepack
- 72162-1499- dantrolene sodium
  - 72162-1499-1- 100 CAPSULE in 1 BOTTLE (72162-1499-1)

72162- Bryant Ranch Prepack
- 72162-2045- Dantrolene Sodium
  - 72162-2045-1- 100 CAPSULE in 1 BOTTLE (72162-2045-1)

72162- Bryant Ranch Prepack
- 72162-2046- Dantrolene Sodium
  - 72162-2046-1- 100 CAPSULE in 1 BOTTLE (72162-2046-1)

72162- Bryant Ranch Prepack
- 72162-2047- Dantrolene Sodium
  - 72162-2047-1- 100 CAPSULE in 1 BOTTLE (72162-2047-1)

72162- Bryant Ranch Prepack
- 72162-2047- Dantrolene Sodium
  - 72162-2047-9- 90 CAPSULE in 1 BOTTLE (72162-2047-9)

78670- USWM, LLC
- 78670-003- Revonto
  - 78670-003-67- 6 VIAL, GLASS in 1 CARTON (78670-003-67) / 60 mL in 1 VIAL, GLASS

84549- ProPharma Distribution
- 84549-003- Revonto
  - 84549-003-67- 60 mL in 1 VIAL, GLASS (84549-003-67)

86184- MAEDA INC
- 86184-061-
  - 86184-061-01- 1 g in 1 PACKAGE (86184-061-01)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇