A
new formula-
tion of dantro-
lene called
Ryanodex (Eagle
Pharmaceuticals) lets
you get much more
antidote into the
patient much faster
during a malignant
hyperthermia crisis,
but it's unknown
whether a bigger, faster loading dose of dantrolene is clinically help-
ful.
Just 1 vial of Ryanodex provides a loading dose (2.5 mg/kg) of dantro-
lene sodium for most patients. The company says Ryanodex can be pre-
pared and administered in less than 1 minute, compared with 15 to 20
minutes for conventional dantrolene, which requires multiple 20 mg vials,
each reconstituted in 60 mL of sterile water. Each vial of Ryanodex con-
tains 250 mg of dantrolene sodium and requires reconstitution with
only 5 mL of sterile water for injection. Once you have the first vial of
Revonto or Dantrium reconstituted, you can begin administering the
antidote, but for an adult patient, you'll need to keep mixing and recon-
stituting — 8 or 10 or 12 more vials — to keep it flowing.
But you'll pay for the convenience Ryanodex provides. As you'll see
in the table below, Ryanodex costs more than twice as much as, and
has a shorter shelf life than, Revonto (US WorldMeds) and Dantrium
: Is the Convenience Of a
New MH Antidote Worth the Cost?
MALIGNANT HYPERTHERMIA
MH DRILL In a malignant hyperthermia emergency, the sooner
you start treatment after you make a diagnosis, the better.
SURGEONS'
Lounge
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