Neuromuscular Blocking Agent (Non-Depolarising) Pregnancy: Should not be used during pregnancy — no adequate data; potential risk to humans unknown. Short half-life; breast-feeding may resume ~3 hours after the last dose/end of infusion.

Cisatracurium

Brand names: Nimbex

Cisatracurium is an intermediate-acting non-depolarising neuromuscular blocking agent used to provide muscle relaxation during anaesthesia and to facilitate intubation and mechanical ventilation, including in intensive care.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.15 mg/kg IV bolus for tracheal intubation (produces good to excellent intubating conditions ~120 seconds after administration following propofol induction)

Route: Intravenous bolus injection (also given by infusion for maintenance)

Frequency: Single intubation dose; maintenance 0.03 mg/kg (~20 minutes of additional block)

Higher doses (studied up to 0.4 mg/kg) shorten onset. Maintenance: 0.03 mg/kg provides ~20 minutes additional clinically effective block during opioid or propofol anaesthesia; consecutive maintenance doses do not progressively prolong effect. Enflurane or isoflurane anaesthesia may extend duration by up to ~15%. Myasthenia gravis and other neuromuscular disease: initial dose not more than 0.02 mg/kg. Neuromuscular monitoring recommended to individualise dosing. Do not mix in the same syringe/needle as propofol or alkaline solutions (e.g. sodium thiopentone).

Paediatric dose

Dose: 0.15 mg/kg

Route: IV bolus over 5–10 seconds

Frequency: single intubation dose; maintenance 0.02 mg/kg (aged 2–12 years)

For tracheal intubation in paediatric patients aged 1 month to 12 years; produces good to excellent intubating conditions ~120 seconds after injection. When not required for intubation a dose of less than 0.15 mg/kg may be used. Maintenance (aged 2–12 years) 0.02 mg/kg provides ~9 minutes additional block during halothane anaesthesia; halothane may extend duration up to ~20%. Not studied in neonates under 1 month.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to cisatracurium, atracurium or benzenesulfonic acid, or to any excipient

Side effects

Bradycardia (common)
Hypotension (common)
Cutaneous flushing (uncommon)
Bronchospasm (uncommon); rash (uncommon)
Anaphylactic reaction / anaphylactic shock (very rare); myopathy/muscle weakness after prolonged ICU use (very rare)

Interactions

Suxamethonium (succinylcholine) — may decrease time to onset of maximum block
Inhalational anaesthetics, aminoglycoside/other antibiotics, local anaesthetics, magnesium salts, procainamide, lithium, quinidine — may potentiate or prolong neuromuscular block
Phenytoin and carbamazepine — may shorten duration of neuromuscular block
(Interactions drawn from the US label §7; UK SPC §4.5 not present in the fetched eMC extract)

Clinical monograph

How it works

It is a single isomer of atracurium that competitively blocks acetylcholine at nicotinic receptors of the neuromuscular junction, preventing end-plate depolarisation and producing paralysis.

Prescribing in practice

It produces complete respiratory paralysis and must only be used where airway control and mechanical ventilation can be maintained by experienced clinicians.
Like atracurium it is eliminated by organ-independent Hofmann degradation, making it suitable in renal or hepatic impairment, but it causes less histamine release.
It has no sedative or analgesic properties, so adequate anaesthesia must be ensured to avoid awareness during paralysis.

Monitoring

Monitor neuromuscular function with a peripheral nerve stimulator and confirm recovery before extubation.

Counselling the patient

Remind the team that the patient is fully dependent on ventilation while paralysed.
Ensure sedation and analgesia are titrated alongside the block.

Evidence & guidelines

Its use reflects established anaesthetic and critical-care practice, with neuromuscular monitoring recommended by professional anaesthetic guidance.

Reference: ACURASYS trial (NEJM 2010); AAGBI Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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