Anesth Pain Med.  2023 Jul;18(3):220-232. 10.17085/apm.22260.

Current clinical application of dantrolene sodium

• Yang HS
• Choi JM
• In J
• Sung Ty
• Kim YB
• Sultana S

• KMID: 2547030
• DOI: http://doi.org/10.17085/apm.22260

Abstract

Dantrolene sodium (DS) was first introduced as an oral antispasmodic drug. However, in 1975, DS was demonstrated to be effective for managing malignant hyperthermia (MH) and was adopted as the primary therapeutic drug after intravenous administration. However, it is difficult to administer DS intravenously to manage MH. MH is life-threatening, pharmacogenomically related, and induced by depolarizing neuromuscular blocking agents or inhalational anesthetics. All anesthesiologists should know the pharmacology of DS. DS suppresses Ca2+ release from ryanodine receptors (RyRs). RyRs are expressed in various tissues, although their distribution differs among subtypes. The anatomical and physiological functions of RyRs have also been demonstrated as effective therapeutic drugs for cardiac arrhythmias, Alzheimer’s disease, and other RyR-related diseases. Recently, a new formulation was introduced that enhanced the hydrophilicity of the lipophilic DS. The authors summarize the pharmacological properties of DS and comment on its indications, contraindications, adverse effects, and interactions with other drugs by reviewing reference articles.

Keyword

Adverse events; Dantrolene; Malignant hyperthermia; Pharmacology; Ryanodine receptor calcium release channel

Figure

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  Fig. 1. The chemical structure of dantrolene sodium.

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  Fig. 2. The chemical structure of Revento® and Ryanodex® (dantrolene sodium for injection). These two drugs have the same chemical structure, but the chemical mixture is different.

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  Fig. 3. The chemical structure of azumolene sodium.

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  Fig. 4. Algorithm for managing malignant hyperthermia. NMBA: neuromuscular blocking agents, EtCO2: end-tidal carbon dioxide, V/S: vital sign, ICU: intensive care unit, MH: malignant hyperthermia, IVCT: in vitro contracture test.

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