McKenna's Drug Handbook for Nursing & Midwifery, 7e

Muscle relaxants     781

CV: hypotension, hypertension. ENT: nasal congestion, slurred speech. Eye: blurred vision. GI: nausea, constipation, vomiting. GU: urinary frequency. Hepatic: increased AST and alkaline phos­ phatase levels. Metabolic: hyperglycaemia, weight gain. Respiratory: dyspnoea. Skin: rash, pruritus, excessive sweating. Interactions Drug-drug. Antihypertensives: Additiveeffects. Adjust antihypertensive dosage accordingly. CNS depressants: Increased CNS depression. Avoid use together. Levodopa/carbidopa: Possible mental confusion, hallucinations, headaches, nausea and agitation. Monitor closely. Lithium: Aggravatedhyperkineticsymptoms. Monitor closely. MAO inhibitors: Increased CNS depression and hypotension. Use cautiously and consider reduced dose. Tricyclic antidepressants: Increased effects of baclofen and increasedmuscular hypotonia. Monitor closely. Drug-lifestyle. Alcohol use: Increased CNS depression. Advise person to avoid alcohol use. Contraindications Contraindicated in individualshypersensitive to drug. care considerations • Use cautiously in individuals with impaired renal function or seizure disorders or when spasticity is used tomaintainmotor function. • Consider reduced dose in elderly adults and in individuals with renal impairment. • Give oral form with meals or with milk to prevent GI distress. • Orally administered drug should not be used to treat muscle spasm caused by rheumatic disorders, cerebral palsy, Parkinson’s disease or CVA because efficacy has not been established.

• Do not administer intrathecal injection by IV, IM, SC or epidural route. • Watch for sensitivity reactions, such as fever, skin eruptions and respiratory distress. • Anticipate increased risk of seizures in individuals with seizure disorder. • Amount of relief determines whether dosage (and drowsiness) can be reduced. • Do not withdraw drug abruptly after long-term use unless required by adverse reactions; may trigger hallucinations or rebound spasticity. • Experience with long-term intrathecal use suggests that about 10% of individuals may develop tolerance to drug. In some cases, this may be treated by hospitalising person and slowly withdrawing drug over 2-week period. Patient teaching • Instruct person to take oral form with meals or milk to prevent GI distress. • Advise person to avoid activities that require alertness until drug’s CNS effects are known. Drowsiness is usually transient. • Advise person to avoid alcohol when taking drug. • Instruct person to follow prescriber’s orders regarding rest and physical therapy.

dantrolene sodium Dantrium, Dantrium IV Pregnancy risk category B2 Use in sport: Permitted Available forms Capsules: 25 mg, 50 mg Powder for injection: 20 mg/vial Indications & dosages

➤ Spasticityandsequelaesecondarytosevere chronic disorders (such as multiple sclerosis, cerebral palsy, spinal cord injury, CVA)— Adults: 25mg PO daily. Increased gradually in 25-mg increments, up to 100 mg b.i.d. to q.i.d., to maximum of 400 mg daily.