Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Non-depolarizing neuromuscular blocking agent
Original Date: 
August 2005
Revised Date: 
January 2016
  • Skeletal muscle relaxation during surgery or mechanical ventilation
  • Adjunct to general anesthesia
  • Facilitates endotracheal intubation
Reconstitution and Stability: 
  • Refrigerate vials; unopened vials stable 6 months at room temperature
  • Diluted solutions stable 24 hrs at room temperature

- Solutions Compatible: D5W, NS, D5W-NS, ringer's lactate

- Additive/buretrol Compatible: no information

- Y-site Compatible: esmolol, fentanyl, midazolam, milrinone, morphine, KCl

- Incompatible: alkaline solutions, cefazolin, cloxacillin, dexamethasone, furosemide, hydrocortisone sodium succinate, insulin, ketorolac, lorazepam, methylprednisolone, vancomycin


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

Usual dilution: undiluted
Infusion time: 5-15 seconds

IV Intermittent Infusion NO
IV Continuous Infusion YES
Usual dilution: 0.5-1 mg/mL

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

ICU paralysis (eg. facilitate mechanical ventilation) in selected adequately sedated patients

  • 0.6 - 1.2 mg/kg/dose for both intubating and ongoing neuromuscular blockade - can be as frequent as every 30 minutes
Potential hazards of parenteral administration: 
  • Arrhythmia, hypotension or hypertension, tachycardia
  • Injection site edema, rash
  • Histamine release is unlikely following usual doses
  • Ventilation must be supported during neuromuscular blockade
  • Monitor heart rate, blood pressure, assisted ventilation status, peripheral nerve stimulator measuring twitch response
  • Many potential drug interactions: Contact Pharmacy
  • Electrolyte abnormalities (severe hyponatremia, hypocalcemia and hypokalemia, hypermagnesemia), renal and hepatic failure potentiate the neuromuscular blockade.
  • Antidote: anticholinesterase agents such as neostigmine or edrophonium, in conjunction with an anticholinergic agent (e.g. atropine, glycopyrrolate)
  • Short acting
  • Peak effect: 30 seconds - 1 minute (children)
  • Duration: 30-40 minutes (dose related)

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