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Dantrolene

Oral
Intravenous
Class
Skeletal muscle relaxants
Subclass
Ryanodine receptor antagonists
Substance name
Dantrolene sodium
Brand names
Dantrium®
Common formulations
Capsule
Dosage and administration
Adults patients
Treatment of chronic spasticity in patients with upper motor neuron disease
•
25 mg PO daily for 7 days, followed by an increase in the dosage frequency
Indications for use
Labeled indications
Adults
•
Treatment of chronic spasticity in patients with upper motor neuron disease
•
Prevention of malignant hyperthermia (preoperative administration)
Safety risks
Contraindications
Active hepatic disease
Warnings and precautions
Myopathy
•
Use caution with pre-existing neuromuscular disease.
Pericarditis
•
Use caution with severe cardiac function impairment.
Respiratory depression
•
Use caution with pulmonary disease, particularly COPD.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for hematuria, crystalluria and hepatotoxicity.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required. Monitor for crystalluria, hematuria and hepatotoxicity.
Hepatic impairment
Any severity
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Use only if benefits outweigh potential risks. There are risks to both the pregnant woman and fetus associated with untreated malignant hyperthermia, including death. Life-sustaining therapy should not be withheld due to pregnancy.
•
Dantrolene, when given for non-life-saving indications, should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, particularly during the first or second trimester where data are lacking.
Breastfeeding
Little information available on breastfeeding safety.
•
Consider alternative agents that may be safer.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Dystonia, dysphagia, headache, skin flushing, somnolence
Common 1-10%
•
AV block, asthenia, blurred vision, dizziness, malaise, nausea, vomiting, sinus tachycardia
Unknown frequency
•
Acute liver failure, anaphylaxis, anemia, aplastic anemia, ↓ WBC count, ↓ platelet count, diaphoresis, dystonia, erectile dysfunction, gastritis, gastrointestinal bleeding, heart failure, hepatotoxicity, hyperlacrimation, ↑ liver enzymes, ↑ serum TBIL, jaundice, liver cirrhosis, pericarditis, phlebitis, photosensitivity of skin, pleural effusion, pulmonary edema, abdominal pain, back pain, chills, confusion, constipation, depression, diarrhea, diplopia, dysgeusia, dyspnea, fatigue, fever, hematuria, insomnia, itching, loss of appetite, myalgia, nocturia, seizure, urinary incontinence, urinary retention, visual disturbances, weakness, respiratory depression, skin erythema, tissue necrosis, urticaria
Interactions
Drug(s)
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