Nimbex (Cisatracurium) Loading Dose Recommendations
The recommended loading dose of Nimbex (cisatracurium) for adult patients is 0.15-0.2 mg/kg IV administered over 5-10 seconds. 1
Adult Dosing Guidelines
- The FDA-approved loading dose for cisatracurium in adults is 0.15 mg/kg (3 × ED95) or 0.2 mg/kg (4 × ED95), administered intravenously over 5-10 seconds 1
- The 0.2 mg/kg dose provides slightly faster onset and more excellent intubation conditions compared to the 0.15 mg/kg dose 1
- The clinically effective duration of action for these doses during propofol anesthesia is approximately 55 minutes (range: 44-74 minutes) for 0.15 mg/kg and 61 minutes (range: 41-81 minutes) for 0.2 mg/kg 1
Special Patient Populations
- For elderly patients and those with renal dysfunction, the same initial loading dose is recommended, but a longer interval between administration and intubation attempt may be required 1
- In critically ill ICU patients, higher cumulative doses may be needed to achieve complete neuromuscular blockade compared to elective surgical patients 2
- For patients with coronary artery disease, a loading dose of 0.1 mg/kg (2 × ED95) has been safely used with minimal hemodynamic effects 3
Pediatric Dosing
- For children 2-12 years: 0.1-0.15 mg/kg IV administered over 5-10 seconds 1
- For infants 1-23 months: 0.15 mg/kg IV administered over 5-10 seconds 1
Monitoring Recommendations
- Use of a peripheral nerve stimulator is strongly recommended to optimize dosing, minimize the possibility of overdosage or underdosage, and assess recovery 1
- In the ICU setting, neuromuscular monitoring should be used as ICU patients may require higher cumulative doses than predicted 2
Clinical Considerations
- Cisatracurium has minimal cardiovascular effects and does not cause significant histamine release at recommended doses 3
- The onset of action may be affected by co-induction agents (e.g., fentanyl and midazolam) and the depth of anesthesia 1
- Volatile anesthetics like isoflurane or enflurane may prolong the duration of action of cisatracurium, potentially requiring less frequent maintenance dosing 1
Common Pitfalls to Avoid
- Failure to use neuromuscular monitoring may lead to inadequate paralysis or prolonged recovery 1, 2
- Not accounting for the delayed onset of neuromuscular blockade in ICU patients compared to elective surgical patients 2
- Underestimating the dose requirements in critically ill patients, who may need significantly higher cumulative doses to achieve complete paralysis 2