dantrolene (Rx)

Brand and Other Names:Dantrium, Revonto, more...Ryanodex
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 25mg
  • 50mg
  • 100mg

powder for injection

  • 20mg/vial (Dantrium, Revonto)
  • 250mg/vial (Ryanodex)

Malignant Hyperthermia (Per MHAUS)

2.5 mg/kg rapid IV bolus, repeat PRN  

Sometimes >10 mg/kg (cumulative dose) is necessary (up to 30 mg/kg)

Maintenance: 1 mg/kg IV q4-6hr OR 0.25 mg/kg/hr IV infusion

Monitor overnight in hospital for 24-48 hr

For more information, see Malignant Hyperthermia Association of the United States (MHAUS) recommendations; https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/

Malignant Hyperthermia, Prevention

NOT recommended by MHAUS

1-3 days before surgery: 4-8 mg/kg/day PO divided q6hr  

75 minutes before anesthesia: 2.5 mg/kg IV once over 60 minutes; administer additional doses PRN

Spasticity

25 mg PO qDay for 7 days, THEN

25 mg PO q8hr for 7 days, THEN

50 mg PO q8hr for 7 days, THEN

100 mg PO q8hr, not to exceed 100 mg PO q6hr

Discontinued if no benefits within 6-7 weeks

Neuroleptic Malignant Syndrome (Off-label)

25 mg/day IV; gradually increase to 150 mg/day

Succinylcholine-induced Fasciculations & Post-op Muscle Pain (Off-label)

<45 kg: 100 mg PO 2 hr pre-op

≥45 kg: 150 mg PO 2 hr pre-op

Monitor: LFTs, bilirubin

Wolfram Syndrome (Orphan)

Orphan designation for treatment of Wolfram Syndrome

Sponsor

  • Washington University in St. Louis; 660 S. Euclid Avenue, Campus Box 8127; St. Louis, Missouri 63110

Organophosphate Exposure (Orphan)

Ryanodex: Orphan designation for treatment of organophosphate exposure

Sponsor

  • Eagle Pharmaceuticals, Inc; 50 Tice Blvd, Suite 315; Woodcliff Lake, New Jersey 07677

Other Indications & Uses

Off-label: Muscle pain in Duchenne muscular dystrophy, muscle pain in phosphorylase deficiency (exercise), to reduce succinylcholine-induced fasciculations & post-op muscle pain, NMS

Dosage Forms & Strengths

capsule

  • 25mg
  • 50mg
  • 100mg

powder for injection

  • 20mg/vial (Dantrium, Revonto)
  • 250mg/vial (Ryanodex)

Malignant Hyperthermia (Per MHAUS)

2.5 mg/kg rapid IV bolus, repeat PRN  

Sometimes >10 mg/kg (cumulative dose) is necessary (up to 30 mg/kg)

Maintenance: 1 mg/kg IV q4-6hr OR 0.25 mg/kg/hr IV infusion

Monitor overnight in hospital for 24-48 hr

For more information, see Malignant Hyperthermia Association of the United States (MHAUS) recommendations; https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/

Malignant Hyperthermia, Prevention

NOT recommended by MHAUS

1-3 days before surgery: 4-8 mg/kg/day PO divided q6hr  

75 minutes before anesthesia: 2.5 mg/kg IV once over 60 minutes; administer additional doses PRN

Spasticity

Monitor: LFTs, bilirubin

≥5 Years

  • 0.5 mg/kg PO qDay for 7 days, THEN  
  • 0.5 mg/kg PO q8hr for 7 days, THEN
  • 1 mg/kg PO q8hr for 7 days, THEN
  • 2 mg/kg PO q8hr, not to exceed 100 mg PO q6hr

<5 Year

  • Initial: 1 mg/kg/day PO divided q12hr
  • Maximum maintenance: 12 mg/kg/day PO divided q6hr
  • Not to exceed 3 mg/kg PO q6-12hr OR 400 mg/24 hr PO

See adult dosing

Spontaneous reports suggest a higher proportion of hepatic events with fatal outcome in elderly patients

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Interactions

Interaction Checker

and dantrolene

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            Contraindicated (8)

            • amlodipine

              dantrolene, amlodipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            • diltiazem

              dantrolene, diltiazem. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            • felodipine

              dantrolene, felodipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            • levamlodipine

              dantrolene, levamlodipine. Either increases toxicity of the other by unspecified interaction mechanism. Contraindicated. Cardiovascular collapse in association with marked hyperkalemia has been reported in patients receiving dantrolene in combination with calcium channel blockers. .

            • nicardipine

              dantrolene, nicardipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            • nisoldipine

              dantrolene, nisoldipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            • vecuronium

              dantrolene, vecuronium. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. May potentiate vecuronium-induced neuromuscular block.

            • verapamil

              dantrolene, verapamil. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            Serious - Use Alternative (21)

            • abametapir

              abametapir will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • apalutamide

              apalutamide will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • calcium/magnesium/potassium/sodium oxybates

              dantrolene, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • carbamazepine

              carbamazepine will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • enzalutamide

              enzalutamide will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • hydrocodone

              hydrocodone, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • idelalisib

              idelalisib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • ivosidenib

              ivosidenib will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • lonafarnib

              lonafarnib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • metoclopramide intranasal

              dantrolene, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • pexidartinib

              dantrolene and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

            • phenobarbital

              phenobarbital will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • phenytoin

              phenytoin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • primidone

              primidone will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • sodium oxybate

              dantrolene, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sufentanil SL

              sufentanil SL, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tucatinib

              tucatinib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • voxelotor

              voxelotor will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (172)

            • abobotulinumtoxinA

              dantrolene increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • alfentanil

              dantrolene and alfentanil both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and dantrolene both increase sedation. Use Caution/Monitor.

            • amitriptyline

              dantrolene and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and dantrolene both increase sedation. Use Caution/Monitor.

              amobarbital will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amoxapine

              dantrolene and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              dantrolene and apomorphine both increase sedation. Use Caution/Monitor.

            • aripiprazole

              dantrolene and aripiprazole both increase sedation. Use Caution/Monitor.

            • azelastine

              azelastine and dantrolene both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and dantrolene both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              dantrolene and belladonna and opium both increase sedation. Use Caution/Monitor.

            • belzutifan

              belzutifan will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

            • benperidol

              dantrolene and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              dantrolene increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bosentan

              bosentan will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • brexanolone

              brexanolone, dantrolene. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and dantrolene both increase sedation. Use Caution/Monitor.

            • buprenorphine

              dantrolene and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              dantrolene and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              buprenorphine, long-acting injection increases effects of dantrolene by Other (see comment). Modify Therapy/Monitor Closely. Comment: Buprenorphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and increase risk for respiratory depression. Monitor for signs of respiratory depression that may be greater than otherwise expected and decrease muscle relaxant dosage as necessary.

            • butabarbital

              butabarbital and dantrolene both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and dantrolene both increase sedation. Use Caution/Monitor.

            • butorphanol

              dantrolene and butorphanol both increase sedation. Use Caution/Monitor.

            • carbamazepine

              dantrolene will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor plasma levels when used concomitantly

            • carbinoxamine

              carbinoxamine and dantrolene both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and dantrolene both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

              cenobamate, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and dantrolene both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and dantrolene both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and dantrolene both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              dantrolene and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chlorzoxazone and dantrolene both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and dantrolene both increase sedation. Use Caution/Monitor.

            • clemastine

              clemastine and dantrolene both increase sedation. Use Caution/Monitor.

            • clobazam

              dantrolene, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              dantrolene and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and dantrolene both increase sedation. Use Caution/Monitor.

            • clozapine

              dantrolene and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              dantrolene and codeine both increase sedation. Use Caution/Monitor.

            • crofelemer

              crofelemer increases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • cyclizine

              cyclizine and dantrolene both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              cyclobenzaprine and dantrolene both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and dantrolene both increase sedation. Use Caution/Monitor.

            • dabrafenib

              dabrafenib will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • desipramine

              dantrolene and desipramine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and dantrolene both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              dantrolene increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and dantrolene both increase sedation. Use Caution/Monitor.

            • dextromoramide

              dantrolene and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              dantrolene and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, dantrolene. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • difenoxin hcl

              dantrolene and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and dantrolene both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and dantrolene both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              dantrolene and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              dantrolene and dipipanone both increase sedation. Use Caution/Monitor.

            • dopexamine

              dantrolene increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              dantrolene and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              dantrolene and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and dantrolene both increase sedation. Use Caution/Monitor.

            • droperidol

              dantrolene and droperidol both increase sedation. Use Caution/Monitor.

            • efavirenz

              efavirenz will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, dantrolene. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • esketamine intranasal

              esketamine intranasal, dantrolene. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and dantrolene both increase sedation. Use Caution/Monitor.

            • ethanol

              dantrolene and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and dantrolene both increase sedation. Use Caution/Monitor.

            • etravirine

              etravirine will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • fenfluramine

              dantrolene increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fluphenazine

              dantrolene and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • haloperidol

              dantrolene and haloperidol both increase sedation. Use Caution/Monitor.

            • hydromorphone

              dantrolene and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and dantrolene both increase sedation. Use Caution/Monitor.

            • iloperidone

              dantrolene and iloperidone both increase sedation. Use Caution/Monitor.

              iloperidone increases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • imipramine

              dantrolene and imipramine both increase sedation. Use Caution/Monitor.

            • incobotulinumtoxinA

              dantrolene, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • istradefylline

              istradefylline will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • ketamine

              ketamine and dantrolene both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              dantrolene and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, dantrolene. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levorphanol

              dantrolene and levorphanol both increase sedation. Use Caution/Monitor.

            • lofepramine

              dantrolene and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              dantrolene and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              loprazolam and dantrolene both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • lorlatinib

              lorlatinib will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • loxapine

              dantrolene and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              dantrolene and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, dantrolene. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              dantrolene and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              dantrolene and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              dantrolene and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              dantrolene and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              dantrolene and meprobamate both increase sedation. Use Caution/Monitor.

            • metaxalone

              dantrolene and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              dantrolene and methadone both increase sedation. Use Caution/Monitor.

            • methocarbamol

              dantrolene and methocarbamol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              dantrolene increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and dantrolene both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, dantrolene. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • mirtazapine

              dantrolene and mirtazapine both increase sedation. Use Caution/Monitor.

            • mitotane

              mitotane decreases levels of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • morphine

              dantrolene and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              dantrolene and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              dantrolene and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              dantrolene and nabilone both increase sedation. Use Caution/Monitor.

            • nafcillin

              nafcillin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nalbuphine

              dantrolene and nalbuphine both increase sedation. Use Caution/Monitor.

            • nortriptyline

              dantrolene and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              dantrolene and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              oliceridine, dantrolene. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              dantrolene increases toxicity of oliceridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor for signs of urinary retention or reduced gastric motility if oliceridine is coadministered with anticholinergics.

            • opium tincture

              dantrolene and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              dantrolene and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • oxycodone

              dantrolene and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              dantrolene and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              dantrolene and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              dantrolene and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              dantrolene and papaverine both increase sedation. Use Caution/Monitor.

            • pentazocine

              dantrolene and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and dantrolene both increase sedation. Use Caution/Monitor.

            • perphenazine

              dantrolene and perphenazine both increase sedation. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and dantrolene both increase sedation. Use Caution/Monitor.

            • phenylephrine PO

              dantrolene increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              dantrolene and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              dantrolene and pimozide both increase sedation. Use Caution/Monitor.

            • prabotulinumtoxinA

              dantrolene increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Muscle relaxants may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • primidone

              primidone and dantrolene both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              dantrolene and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and dantrolene both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and dantrolene both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              dantrolene increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              dantrolene and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • quetiapine

              dantrolene and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              dantrolene and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, dantrolene. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • rifabutin

              rifabutin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • risperidone

              dantrolene and risperidone both increase sedation. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • scullcap

              dantrolene and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and dantrolene both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              dantrolene and shepherd's purse both increase sedation. Use Caution/Monitor.

            • stiripentol

              stiripentol, dantrolene. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

              stiripentol, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              dantrolene and sufentanil both increase sedation. Use Caution/Monitor.

            • tapentadol

              dantrolene and tapentadol both increase sedation. Use Caution/Monitor.

            • tazemetostat

              tazemetostat will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • temazepam

              temazepam and dantrolene both increase sedation. Use Caution/Monitor.

            • thioridazine

              dantrolene and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              dantrolene and thiothixene both increase sedation. Use Caution/Monitor.

            • topiramate

              dantrolene and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              dantrolene and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              dantrolene and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and dantrolene both increase sedation. Use Caution/Monitor.

            • triclofos

              triclofos and dantrolene both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              dantrolene and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              dantrolene and trimipramine both increase sedation. Use Caution/Monitor.

            • xylometazoline

              dantrolene increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              dantrolene and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              dantrolene and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              dantrolene and zotepine both increase sedation. Use Caution/Monitor.

            Minor (3)

            • eucalyptus

              dantrolene and eucalyptus both increase sedation. Minor/Significance Unknown.

            • ribociclib

              ribociclib will increase the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sage

              dantrolene and sage both increase sedation. Minor/Significance Unknown.

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            Adverse Effects

            Frequency Not Defined

            Increased serum AST (SGOT), ALT (SGPT), alkaline phosphatase, LDH, BUN, and total serum bilirubin concentrations

            Fatal/nonfatal hepatitis

            Diarrhea

            Anorexia

            Nausea

            Vomiting

            Gastric irritation

            Abdominal cramps

            Constipation

            Dysphagia

            GI bleeding

            Adynamic ileus

            Speech disturbance

            Headache

            Visual disturbances

            Dysgeusia

            Mental depression

            Confusion

            Auditory/visual hallucinations

            Increased nervousness

            Insomnia

            Drooling

            Exacerbation/precipitation of seizures

            Muscle weakness

            Drowsiness

            Dizziness

            Urinary frequency/incontinence

            Nocturia

            Difficult urination/urinary retention

            Crystalluria, hematuria

            Difficult erection

            Abnormal hair growth

            Acneiform rash

            Eczematoid eruption

            Pruritus, urticaria

            Sweating

            Tachycardia

            Erratic blood pressure

            Phlebitis

            Heart failure

            Aplastic anemia

            Anemia

            Leukopenia

            Lymphocytic

            Lymphoma

            Thrombocytopenia

            Respiratory depression

            Pleural effusion with associated eosinophilia

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            Warnings

            Black Box Warnings

            The incidence of symptomatic (fatal and nonfatal) hepatitis is lower with doses up to 400 mg daily compared to >800 mg daily

            Overt hepatitis has been most frequently observed during third and twelfth months, but may occur at anytime. Risk higher in females and patients >35 years, and with concurrent therapy

            Use only in conjunction with liver monitoring

            Should not be used in conditions other than those recommended; discontinue therapy if benefits not observed within 45 days in chronic spasticity

            Contraindications

            NO CONTRAINDICATIONS for IV use in MH management/prophylaxis

            Hypersensitivity

            Impaired hepatic, cardiac or pulmonary function

            Upper motor neuron disorder

            Patients in whom spasticity is utilized to maintain upright posture & balance

            Cautions

            Possibility of severe hepatotoxicity

            Risk of muscle weakness

            Risk of photosensitivity reactions

            Females, >35 years, receiving other drugs, history of liver disease

            Not indicated in muscle spasms due to rheumatic disorder or musculoskeletal trauma

            Ineffective in ALS

            Use caution when administering oral therapy in patients with severely impaired cardiac function resulting from myocardial disease

            Use caution when administering oral therapy in patients with impaired pulmonary function

            In combination with calcium channel blockers IV dantrolene may increase risk for hyperkalemia and cardiac arrest (combination not recommended)

            Severely impaired cardiac function due to myocardial disease

            Associated with pleural effusion with associated eosinophilia

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            Pregnancy & Lactation

            Pregnancy

            Available data on use in pregnant women are insufficient to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; the drug readily crosses placenta; however, no serious adverse events reported in neonate following maternal administration of drug prior to delivery; there are risks to pregnant woman and fetus associated with untreated malignant hyperthermia

            Malignant hyperthermia is a medical emergency which can be fatal for the pregnant woman and fetus if left untreated; life-sustaining therapy should not be withheld due to pregnancy

            Labor or Delivery

            • In uncontrolled study, 100 mg per day of prophylactic oral dantrolene sodium was administered to term pregnant patients awaiting labor and delivery; the drug readily crossed placenta, with maternal and fetal whole blood levels approximately equal at delivery; neonatal levels then fell approximately 50% per day for 2 days before declining sharply; no neonatal respiratory and neuromuscular side effects were observed in this study

            Animal data

            • In animal reproduction studies, dantrolene sodium administered to rats and rabbits produced embryolethality (rabbits) and decreased pup survival (rats) at doses seven times the human oral dose

            Lactation

            Dantrolene is reported to be present in human milk following intravenous administration over 3 days; there are no data on effects on breastfed infant or effects on milk production; because of potential for serious adverse reactions in breastfed infant, including respiratory depression and muscle weakness, advise patients that breastfeeding is not recommended during treatment and for 3 days after last dose

            A lactating woman should interrupt breastfeeding and pump and discard breast milk during treatment and for 3 days after last dose administered

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Interferes with calcium release within skeletal muscle cells (from sarcoplasmic reticulum)

            Pharmacokinetics

            Peak plasma time: 5 hr

            Concentration: 100 to >600 ng/mL

            Half-life elimination: 4-8hr

            Duration: 3 hr or longer

            Protein Bound: substantial

            Metabolism: Liver

            Metabolites: 5-hydroxy derivative

            Excretion: Urine (25%); feces (45-50%)

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            Administration

            IV Compatibilities

            Sterile water for injection (SWI)

            IV Incompatibilities

            Dextrose solutions

            0.9% NaCl

            Other acidic solutions

            IV Preparation

            Ryanodex

            • Reconstitute each 250 mg vial by adding 5 mL of SWI (not bacteriostatic water for injection)
            • Shake the vial to ensure an orange-colored uniform suspension Visually inspect the vial for particulate matter and discoloration prior to administration

            Dantrium, Revonto

            • Reconstitute each 20 mg vial by adding 60 mL of SWI (not bacteriostatic water for injection)
            • Shake vial for about 20 seconds or until solution is clear
            • Do not transfer reconstituted solutions to large glass bottles for prophylactic infusion due to precipitate formation
            • May transfer to larger volume sterile IV empty plastic bag

            IV Administration

            Therapeutic or emergency dose can be administered with rapid IV push

            Follow-up doses should be administered over 2-3 min

            36 vials (20 mg/vial) are needed for adequate hyperthermia therapy

            Ryanodex

            • Administer the reconstituted suspension either:
            • -Into the IV catheter while an IV infusion of 0.9% NaCal or 5% dextrose injection is freely running; or
            • -Into the indwelling catheter after assuring its patency without a freely running infusion
            • Flush the IV line to assure that there is no residual drug that remains in the catheter

            Storage

            Unreconstituted vials

            • Store controlled room temperature 20-25° C (68-77° F)
            • Avoid prolonged exposure to light

            Reconstituted vials

            • Should be used immediately, but reconstituted solution may be stored at controlled room temperature 20-25° C (68-77° F) and used within 6 hr
            • Protect from direct light
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Dantrium oral
            -
            25 mg capsule
            Dantrium oral
            -
            50 mg capsule
            dantrolene oral
            -
            25 mg capsule
            dantrolene oral
            -
            50 mg capsule
            dantrolene oral
            -
            25 mg capsule
            dantrolene oral
            -
            100 mg capsule
            dantrolene oral
            -
            100 mg capsule
            dantrolene oral
            -
            50 mg capsule
            dantrolene oral
            -
            50 mg capsule
            dantrolene oral
            -
            25 mg capsule
            dantrolene oral
            -
            100 mg capsule
            Dantrium intravenous
            -
            20 mg vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            dantrolene oral

            DANTROLENE - ORAL

            (DAN-trow-leen)

            COMMON BRAND NAME(S): Dantrium

            WARNING: Rarely, dantrolene may cause very serious (possibly fatal) liver problems. The risk is greater if you use high doses of dantrolene (over 400-800 milligrams per day), or are female, older than 35 years, or taking other medications. Signs of liver problems usually appear between 3-12 months of treatment. To reduce your risk of this side effect, you should have regular liver tests checked by your doctor. Tell your doctor right away if you develop any of the following symptoms of liver disease: persistent nausea/vomiting, stomach/abdominal pain, dark urine, yellowing eyes/skin, unusual tiredness.To further reduce your risk of side effects, do not increase your dose or take it more often or for longer than prescribed. The lowest effective dose should be used. The manufacturer recommends that if your condition does not improve after 45 days of treatment, your doctor must be notified and dantrolene should be stopped.

            USES: This medication is used to treat muscle tightness and cramping (spasms) caused by certain nerve disorders such as spinal cord injury, stroke, cerebral palsy, and multiple sclerosis. It works by relaxing the muscles. Dantrolene helps reduce muscle pain and stiffness, improves your ability to move around, and lets you do more of your daily activities.Dantrolene is also used with other treatments to prevent or treat special cases of high fever (malignant hyperthermia) related to anesthesia and surgery.

            HOW TO USE: See also Warning section.Take this medication by mouth as directed by your doctor. For the treatment of long-term muscle tightness/spasms, your doctor may slowly increase your dose to lower your chance of side effects until the right dose for you is determined. The manufacturer recommends that you do not take more than 400 milligrams per day.Dosage is based on your medical condition, response to therapy, and in some cases weight. For the prevention and treatment of malignant hyperthermia, treatment lasts for several days.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

            SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, weakness, tiredness, nausea, and diarrhea may occur as your body adjusts to this medication and usually lessen after several days. Headache, constipation, trouble speaking, and drooling may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: vision changes, black/tarry stools, vomit that looks like coffee grounds, mental/mood changes, trouble swallowing, problems with urination, severe/persistent constipation, seizures, fast heartbeat, easy bruising/bleeding, signs of infection (such as fever, chills, persistent sore throat), chest pain, swelling of the ankles/feet, trouble breathing.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking dantrolene, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems (such as hepatitis, cirrhosis), breathing problems (such as chronic obstructive pulmonary disease-COPD), heart problems.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctors or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), other muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe muscle weakness, severe tiredness, severe drowsiness.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as liver function tests) should be performed periodically to check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light, moisture, and heat. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.