MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name:	Dantrolene IV
Brand Name:	Dantrium® IV
Action:	Skeletal muscle relaxant
Indications:	Treatment of malignant hyperthermia Adjunctive treatment for Neuroleptic Malignant syndrome
Restrictions:	A physician must be present during administration on a general care unit
Usual Dosage Range and Route:	Malignant Hyperthermia Treatment (IV): Initial dosing as a continuous rapid IV push: 2.5 mg/kg, which can be repeated until signs and symptoms resolve, a maximum recommended for initial dose is 10 mg/kg. If physiologic and metabolic abnormalities reappear, repeat regimen. Neuroleptic malignant syndrome (IV): Initial dosing as a continuous rapid IV push: 1 mg/kg; may repeat dose up to maximum cumulative dose of 10 mg/kg, then switch to oral dosage. Therapy should be in conjunction with bromocriptine.
Standard Concentration:	As described below
Administration Guidelines:	Reconstitute each vial of dantrolene intravenous 20mg with 60 mL of sterile water for injection USP (without a bacteriostatic agent). Shake the vial until the solution is clear. Dantrolene is not compatible with dextrose or sodium chloride injection, or acidic solutions; lines should be flushed with sterile water for injection USP (without a bacteriostatic agent) before and after administration. The contents of the vial must be protected from direct light and used within 6 hours after reconstitution. Store reconstituted solutions at controlled room temperature (59°F to 86°F or 15°C to 30°C). While stable for 6 hours, it is recommended that the infusion be prepared immediately prior to the anticipated dosage administration time. Reconstituted dantrolene intravenous should not be transferred to large glass bottles for infusion due to precipitate formation observed with the use of some glass bottles as reservoirs. Contents of individual vials maybe transferred to a larger volume sterile intravenous plastic bag. Stability data on file at Procter & Gamble Pharmaceuticals indicate commercially available sterile plastic bags are acceptable drug delivery devices. However, it is recommended that the prepared infusion be inspected carefully for cloudiness and/or precipitation prior to dispensing and administration. Such solutions should not be used.
Special Considerations:	20 mg vial dantrolene sodium, also contains 3g mannitol, and sufficient sodium hydroxide to yield a pH of approximately 9.5 when reconstituted with 60 mL sterile water for injection USP. Care must be taken to prevent extravasation of Dantrolene solution into the surrounding tissues due to the high pH of the intravenous formulation.
Precautions and Side Effects:	Potential side effects of dantrolene include hepatoxixity pulmonary edema, thrombophlebitis, nausea, malaise, light-headedness, muscle weakness, and local irritation.

rev: 3/07