Control of clinical spasticity.

Skeletal Muscle Relaxant include- Carisprodal, Chlorphenesin Maleate, Chlorzoxazone, Chlormezanone, Cyclobenzaprine, Methocarbinol, Metaxalone, Dantrolenes Sodium, Orphenadrine. Refer Orphenadrine

Most frequent- Drowsiness, dizziness, weakness, general malaise, fatigue, diarrhoea.

GI- Constipation, GI bleeding,anorexia, dysphagia, gastric irritation, abdominal cramps, hepatitis.

CNS- Speech disturbance, seizure, headache, lightheadedness, visual disturbance, diplopia, alteration of taste, insomnia, mental depression/confusion, increased nervousness.

Cardiovascular- Tachycardia, erratic blood pressure, phlebitis.

GU- Increased urinary frequency, hematuria, crystalluria, difficult erection, urinary incontinence, nocturia, dyuria, urinary retension.

Dermatologic- Abnormal hair growth, acne-like rash, pruritus, urticaria, ezematoid eruption, sweating.

Musculoskeltal- Myalgia, backache.

Miscellaneous- Chills, fever, feeling of suffocation, excessive tearing, pleural effusion with pericarditis

Parentral- The following adverse reactions are in approximate order of severity- pulmonary edema developing during treatment of MH crisis, (diluent volume and manitol neded to deliver IV dantrolene possibly contributed). thrombophelebitis folowing IV dantrolene ,urticaria and reyhthema, death.

Active hepatic disease, hepatitis, and cirrhosis, tretment of skeletal muscle spasm resulting from rheumatic disorders. Special precutions: Warnings- Hepatic effects- Fatal and nonfatal liver disorders of an idiosyncratic or hypersensitivty type may occur.

Long term use- Safety and efficacy have not been established. In view of the potential for liver damage in long term use, discontinue therapy if benefits are not evident within 45 days.

Hepatic function impairment- Use with caution in patients when a history of previous liver disease or dysfunction.

Pregnancy- Use only when clearly needed and when the potentail benefits outweigh the potential hazards to the fetus.

Lactation- Do not use in nursing women

Children- safety for use in children < 5 years of age has not been established.

Precautions:

Special risk patients- Use with caution in patients with impaired pulmonary function, particularly those with obstructive pulmoinary disease, severely impaired cardaic function due to myocardial disease.

Extravasation- Because of the high pH of the IV performing extravastion into the surounding tissues.

Hazardous tasks- Patients should use caution while driving orperforming tasks requiring alertness, coordinatin or physical dexterity Photosensitivity- Photosensitization may occur, therfore caution patients to take protective measures (eg sunscreens, protective clothing) against exposure to ultraviolet light or sunlight until tolerance is determined

Indications:

Control of clinical spasticity. Dosage: Adults: Begin with 25mg once daily,increase to 25mg, 2 to 4 times daily; then by increments of 25mg, 2 to 4 times daily; then by increments of 25mg upto as high as 100mg, 2 to 4 times daily if necessary.

Children: Use a similar approach. Start with 0.5mg/kg twice daily; increase to 0.5mg/kg 3 or 4 times daily, the by increments of 0.5mg/kg, upto 3mg/kg to 4 times daily if necessary.

Overdosage- Symptoms/Treatment

1. There is no known antidote.

2. Employ general supportive measures along with immediate gastric lavage

3. Administer IV fluids in fairly large quantities to avert the possibilites of crystalluria

4. Maintain an adequate airway.

5 Have artiificial resusctication equipment available

6. Monitor ECG, observe patoent carefully.

7. No experience has been reported with dialysis.Missed dose- ------------------ 1. If you miss a dose of this medicine, take it as soon as possible. 2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule. 3. Do not double doses.

1.May cause drowsiness, dizziness or lightheadedness. Patients should exercise caution while driving or performing other tasks requiring alertness,cordination or physical dexterity.

2. Avoid alcohol and CNS depressants.

3. Avoid prolonged exposure to sunlight; photosensitivity may occur.

4. May cause weakness,malaise, fatigue, nausea, and diarrhea. Notify physician

5. Notify physician if skin rash, itching, bloody or black tarry stools or yellowish discolouration of skin occurs.

6. Excercise caution at meals on the day of administration because difficulty in swallowing and choking has been reported.

1. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to dantrolene or other related medicines. Also tell your doctor if youn are allergic to any other substances such as foods, preservatives or dyes.

2. Pregnancy- dantrolene has not been shown to cause birth defects in humans.

3. Breast feeding- not recommended

4. Children- has not shown to casue different side effects or problems than it does in adults.

5. Elderly- no specific information comparing use of dantrolene in the elderly in other age groups

6. Other medicines- tell your doctor if you are taking any of the following- Acetaminophen or Amiodarone or Anabolic steroids or Androgens or Anti-infective by mouth or by injection or Anti-thyroid agents or Carbamazepine or Carmustine or Central nervous system or Chloroquine or Daunorubicin or Disulfram or Divalproex or Estrogens or Eretinate or Gold salts or Hydroxycaptopurine or Methotrexate or Methyldopa or Naltrexone or Oral contraceptives containg estrogens or Phenothiazines or Phenytoin or Plicamycin or Tricyclic antidepressants or Valproic acid - chance of side effects may be increased

7. Other medical problems- tell your doctor if you have any other medical problems- Emphysema ,asthma, bronchitis or other chronic lung disease or Heart disease or Liver disease - chance of serious effects may be increased

8. Missed dose- If you miss a dose of this medicine take it as soon as possible. However if it is almost time for your next dose go back to your regular dosing schedule. Do not double doses.

Pharmacology:

Although dantrolene does not appear to directly affect the CNS, the extent of its indirect effect is unknown.

Pharmacokinetics:

Absorption after oral administration is incomplete and slow but consistent,but dose-related blood levels are obtained. Mean half-life in adults is 9 hours after a 100mg oral dose and 4 to 8 hours after IV administration.

Pregnancy- Use only when clearly needed and when the potentail benefits outweigh the potentail hazards to the fetus.

Lactation- Do not use in nursing women

Children- Safety for use in children < 5 years of age has not been established.