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Baclofen - lioresal ®
| Dosing (Adults):
Spasticity: Start 5 mg orally three times daily, increase every 3 days to 20 mg orally three times daily. Max dose: 20 mg orally four times daily (80mg/day).
Hiccups (unlabeled use): 10-20 mg 2-3 times/day.
Intrathecal: Test dose: 50-100 mcg, doses >50 mcg should be given in 25 mcg increments, separated by 24 hours. A screening dose of 25 mcg may be considered in very small patients. Patients not responding to screening dose of 100 mcg should not be considered for chronic infusion/implanted pump. Maintenance: After positive response to test dose, a maintenance intrathecal infusion can be administered via an implanted intrathecal pump. Initial dose via pump: Infusion at a 24-hourly rate dosed at twice the test dose. Avoid abrupt discontinuation.
Supplied: Injection (soln) intrathecal [preservative free] (Lioresal®): 50 mcg/mL (1 mL); 500 mcg/mL (20 mL); 2000 mcg/mL (5 mL). Tablet: 10 mg, 20 mg
PK: Onset of action: 3-4 days. Peak effect: 5-10 days.
Carisprodol - soma ®
|Dosing (Adults): 350 mg orally 3 to 4 times daily|
Cyclobenzaprine - flexeril ®
|Dosing (Adults): Usual dose: 10 mg orally three times daily. Max: 60 mg/day.
[Oral: Initial: 5 mg 3 times/day; may increase to 10 mg 3 times/day if needed. Do not use longer than 2-3 weeks.]
PK: Onset of action: ~1 hour.
Dantrolene - dantrium ®
The minimum initial recommended dose for MALIGNANT HYPERTHERMIA is 1 milligram/kilogram by rapid intravenous injection. If symptoms persist or reappear, the dose may be repeated, to a cumulative dose of 10 milligrams/kilogram. Reversal is usually achieved with a cumulative dose of 2.5 milligrams/kilogram. Oral doses of 1 to 2 milligrams/kilogram 4 times daily for 1 to 3 days may be necessary to prevent recurrence malignant hyperthermia symptoms.
For POST CRISIS FOLLOW-UP OF MALIGNANT HYPERTHERMIA, if oral dantrolene cannot be administered, intravenous dantrolene beginning with 1 milligram/kilogram is recommended. This may be increased as the clinical situation dictates.
Spasticity: Oral: 25 mg/day to start, increase frequency to 2-4 times/day, then increase dose by 25 mg every 4-7 days to a maximum of 100 mg 2-4 times/day or 400 mg/day.
- Postcrisis follow-up: Oral: 4-8 mg/kg/day in 4 divided doses for 1-3 days; I.V. dantrolene may be used when oral therapy is not practical; individualize dosage beginning with 1 mg/kg or more as the clinical situation dictates.
Neuroleptic malignant syndrome (unlabeled use): IV: 1 mg/kg; may repeat dose up to maximum cumulative dose of 10 mg/kg, then switch to oral dosage. Administration - IV: Therapeutic or emergency dose can be administered with rapid continuous I.V. push. Follow-up doses should be administered over 2-3 minutes.
Supplied: 25 mg, 50 mg, 100 mg capsule. Injection (powder for reconstitution): 20 mg vial.
Drug UPDATES: RYANODEX ® (dantrolene sodium) for injectable suspension, for intravenous use.
U.S. Approval: 2014
Mechanism of Action: In isolated nerve-muscle preparation, dantrolene has been shown to produce relaxation by affecting the contractile response of the muscle at a site beyond the myoneural junction. In skeletal muscle, dantrolene dissociates the excitation-contraction coupling, probably by interfering with the release of Ca++ from the sarcoplasmic reticulum.
In the anesthetic-induced malignant hyperthermia syndrome, evidence points to an intrinsic abnormality of skeletal muscle tissue. In affected humans, it has been postulated that "triggering agents" (e.g., general anesthetics and depolarizing neuromuscular blocking agents) produce a change within the cell which results in an elevated myoplasmic calcium. This elevated myoplasmic calcium activates acute cellular catabolic processes that cascade to the malignant hyperthermia crisis.
INDICATIONS AND USAGE:
Diazepam - valium ®
|Dosing (Adults): 2-10 mg orally 3 to 4 times daily.
Sustained release: 15-30 mg orally once daily.
Metaxalone - skelaxin ®
800 mg orally 3 to 4 times daily
Methocarbamol - robaxin ®
Oral: 1.5 g 4 times/day for 2-3 days (up to 8 g/day may be given in severe conditions), then decrease to 4-4.5 g/day in 3-6 divided doses
I.M., I.V.: 1 g every 8 hours if oral not possible; injection should not be used for more than 3 consecutive days. If condition persists, may repeat course of therapy after a drug-free interval of 48 hours.
Dosing: ELDERLY — Muscle spasm: Oral: Initial: 500 mg 4 times/day; titrate to response
Tetanus: I.V.: Initial dose: 1-3 g; may repeat dose every 6 hours until oral dosing is possible; injection should not be used for more than 3 consecutive days
Orphenadrine - norflex ®
|Dosing (Adults): 100 mg orally twice daily.|