Nimbex Caution For Usage

Instructions for Use/Handling: This product is for single use only. Use only clear and almost colourless up to slightly yellow/greenish yellow coloured solutions.
The product should be visually inspected before use, and if the visual appearance has changed or if the container is damaged, the product must be discarded.
Diluted NIMBEX is physically and chemically stable for at least 24 hours at 5°C and 25°C at concentrations between 0.1 and 2 mg/mL in the following infusion fluids, in either polyvinyl chloride or polypropylene containers: Sodium Chloride (0.9% w/v) Intravenous Infusion; Glucose (5% w/v) Intravenous Infusion; Sodium Chloride (0.18% w/v) and Glucose (4% w/v) Intravenous Infusion; Sodium Chloride (0.45% w/v) and Glucose (2.5% w/v) Intravenous Infusion.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
However, since the product contains no antimicrobial preservative, dilution should be carried out immediately prior to use, or failing this be stored as directed under Storage.
NIMBEX has been shown to be compatible with the following commonly used peri-operative drugs, when mixed in conditions simulating administration into a running i.v. infusion via a Y-site injection port: alfentanil hydrochloride, droperidol, fentanyl citrate, midazolam hydrochloride and sufentanil citrate. Where other drugs are administered through the same indwelling needle or cannula as NIMBEX, it is recommended that each drug be flushed through with an adequate volume of a suitable i.v. fluid, e.g. sodium chloride i.v. infusion 0.9% (w/v).
As with other drugs administered intravenously, when a small vein is selected as the injection site, NIMBEX should be flushed through the vein with a suitable i.v. fluid, e.g. sodium chloride i.v. infusion (0.9% w/v).
Instructions to Open the Ampoule: Ampoules are equipped with the OPC (One Point Cut) opening system and must be opened following the instructions as follows: Hold with the hand the bottom part of the ampoule; put the other hand on the top of the ampoule positioning the thumb above the coloured point and press.
Incompatibilities: Degradation of cisatracurium besylate has been demonstrated to occur more rapidly in lactated Ringer's Injection and 5% Dextrose and lactated Ringer's Injection than in the infusion fluids listed previously.
Therefore it is recommended that lactated Ringer's Injection and 5% Dextrose and lactated Ringer's Injection are not used as the diluent in preparing solutions of NIMBEX for infusion.
Since NIMBEX is stable only in acidic solutions it should not be mixed in the same syringe or administered simultaneously through the same needle with alkaline solutions, e.g., sodium thiopentone. It is not compatible with ketorolac trometamol or propofol injectable emulsion.