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Dantrolene
General information
Dantrolene, a hydantoin derivative, is well established in clinical practice, being of greatest value for the reduction of clonus and involuntary muscle spasms [ , ]. The recommended oral doses for the treatment of spastic conditions are 75–400 mg/day.
Dantrolene [ , ] is the agent of choice for treatment of malignant hyperthermia and greatly reduces the mortality to under 10% if given in time [ ] together with general supportive measures.
Dantrolene differs from the centrally acting muscle relaxants in that its site of action is beyond the muscle cell membrane. It interferes with the excitation–contraction coupling mechanism of striated muscle, presumably by inhibition of calcium release from the sarcoplasmic reticulum.
The most common adverse reactions, seen in up to 75% of patients, are weakness, fatigue, drowsiness, and dizziness. Nausea, vomiting, and diarrhea or constipation are also common, but all these adverse reactions tend to disappear as treatment continues. In general, by adjusting the dose a satisfactory effect can be achieved with acceptable adverse effects.
Rare, but occasionally very serious, adverse effects include hepatotoxicity, respiratory depression, seizures, pleuropericardial reaction, and lymphocytic lymphoma [ ].
Organs and systems
Respiratory
Muscle weakness associated with the oral prophylactic use of dantrolene in a patient with compromised respiratory function is reported to have exacerbated postoperative respiratory depression to such an extent that artificial ventilation was required [ ].
Pleuropericardial reactions, with sterile effusions and eosinophilia, have also rarely been reported in patients taking 225–400 mg/day for 3 months to 4 years [ ]. There is no proof of a causal relation, but the chemically related nitrofurantoin has also been associated with pulmonary reactions. Patients taking dantrolene should be screened periodically.
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