Nimbex

DRUG DESCRIPTION

NIMBEX (cisatracurium besylate) is a nondepolarizing skeletal muscle relaxant for intravenous administration. Compared to other neuromuscular blocking agents, it is intermediate in its onset and duration of action. Cisatracurium besylate is one of 10 isomers of atracurium besylate and constitutes approximately 15% of that mixture. Cisatracurium besylate is [1R-[1?,2?(1'R*,2'R*)]]-2,2'-[1,5?­pentanediylbis[oxy(3-oxo-3,1-propanediyl)]]bis[1-[(3,4-dimethoxyphenyl)methyl]-1,2,3,4-tetrahydro?­6,7-dimethoxy-2-methylisoquinolinium] dibenzenesulfonate. The molecular formula of the cisatracurium parent bis-cation is C53H72N2O12 and the molecular weight is 929.2. The molecular formula of cisatracurium as the besylate salt is C65H82N2O18S2 and the molecular weight is 1243.50. The structural formula of cisatracurium besylate is:

NIMBEX®
(cisatracurium besylate) Structural Formula Illustration

The log of the partition coefficient of cisatracurium besylate is -2.12 in a 1-octanol/distilled water system at 25°C.

NIMBEX (cisatracurium besylate) Injection is a sterile, non-pyrogenic aqueous solution provided in 5 mL, 10 mL, and 20 mL vials. The pH is adjusted to 3.25 to 3.65 with benzenesulfonic acid. The 5 mL and 10 mL vials each contain cisatracurium besylate, equivalent to 2 mg/mL cisatracurium. The 20 mL vial, intended for ICU use only, contains cisatracurium besylate, equivalent to 10 mg/mL cisatracurium. The 10 mL vial, intended for multiple-dose use, contains 0.9% benzyl alcohol as a preservative. The 5 mL and 20 mL vials are single-use vials and do not contain benzyl alcohol.

Cisatracurium besylate slowly loses potency with time at a rate of approximately 5% per year under refrigeration (5°C). NIMBEX (cisatracurium besylate) should be refrigerated at 2° to 8°C (36° to 46°F) in the carton to preserve potency. The rate of loss in potency increases to approximately 5% per month at 25°C (77°F). Upon removal from refrigeration to room temperature storage conditions (25°C/77°F), use NIMBEX (cisatracurium besylate) within 21 days, even if rerefrigerated.

What are the possible side effects of cisatracurium (Nimbex)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have any of these serious side effects:

  • slow heart rate;
  • noisy breathing, feeling short of breath;
  • ongoing muscle weakness; or
  • inability to move your muscles.

Less serious side effects may include:

  • feeling light-headed;
  • mild itching or skin rash;...

Read All Potential Side Effects and See Pictures of Nimbex »


Nimbex Patient Information Including Side Effects

Brand Names: Nimbex

Generic Name: cisatracurium (Pronunciation: sis AT ra KURE ee um)

  • What is cisatracurium (Nimbex)?
  • What are the possible side effects of cisatracurium (Nimbex)?
  • What is the most important information I should know about cisatracurium (Nimbex)?
  • What should I discuss with my health care provider before receiving cisatracurium (Nimbex)?
  • How is cisatracurium given (Nimbex)?
  • What happens if I miss a dose (Nimbex)?
  • What happens if I overdose (Nimbex)?
  • What should I avoid after receiving cisatracurium (Nimbex)?
  • What other drugs will affect cisatracurium (Nimbex)?
  • Where can I get more information?

What is cisatracurium (Nimbex)?

Cisatracurium is used to relax the muscles. It works by blocking the signals between your nerves and your muscles.

Cisatracurium is given before general anesthesia in preparing you for surgery. Cisatracurium helps keep your body still during surgery. It also relaxes your throat so a breathing tube can be more easily inserted before the surgery.

Cisatracurium may also be used for other purposes not listed in this medication guide.

What are the possible side effects of cisatracurium (Nimbex)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have any of these serious side effects:

  • slow heart rate;
  • noisy breathing, feeling short of breath;
  • ongoing muscle weakness; or
  • inability to move your muscles.

Less serious side effects may include:

  • feeling light-headed;
  • mild itching or skin rash; or
  • warmth, redness, or tingly feeling under your skin.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about cisatracurium (Nimbex)?

You should not receive this medication if you are allergic to cisatracurium or similar medications used in anesthesia. Also tell your doctor if you are allergic to benzyl alcohol.

Before receiving cisatracurium, tell your doctor if you have a muscle disorder such as myasthenia gravis, paralysis in any part of your body, an electrolyte imbalance, or a history of burn injury.

There may be other drugs that can interact with cisatracurium, especially seizure medication or certain antibiotics. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors.

Follow your doctor's instructions about any restrictions on food, beverages, or activity after you recover from anesthesia.

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