Note: Barbiturates and Cost hydrochloride, being chemically incompatible because of precipitate formation, should not be injected from the same syringe.
If the Cost hydrochloride dose is augmented with diazepam, the two drugs must be given separately. Do not mix Cost hydrochloride and diazepam in syringe or infusion flask. For additional information on the use of diazepam, refer to the WARNINGS and DOSAGE AND ADMINISTRATION Sections of the diazepam insert.
Because of rapid induction following the initial intravenous injection, the patient should be in a supported position during administration.
The onset of action of Cost hydrochloride is rapid; an intravenous dose of 2 mg/kg (1 mg/lb) of body weight usually produces surgical anesthesia within 30 seconds after injection, with the anesthetic effect usually lasting five to ten minutes. If a longer effect is desired, additional increments can be administered intravenously or intramuscularly to maintain anesthesia without producing significant cumulative effects.
Intramuscular doses, in a range of 9 to 13 mg/kg (4 to 6 mg/lb) usually produce surgical anesthesia within 3 to 4 minutes following injection, with the anesthetic effect usually lasting 12 to 25 minutes.
As with other general anesthetic agents, the individual response to Cost hydrochloride is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient's requirements.
The initial dose of Cost hydrochloride administered intravenously may range from 1 mg/kg to 4.5 mg/kg (0.5 to 2 mg/lb). The average amount required to produce five to ten minutes of surgical anesthesia has been 2 mg/kg (1 mg/lb).
Alternatively, in adult patients an induction dose of 1 mg to 2 mg/kg intravenous Cost at a rate of 0.5 mg/kg/min may be used for induction of anesthesia. In addition, diazepam in 2 mg to 5 mg doses, administered in a separate syringe over 60 seconds, may be used. In most cases, 15 mg of intravenous diazepam or less will suffice. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this induction dosage program.
Note: The 100 mg/mL concentration of Cost hydrochloride should not be injected intravenously without proper dilution. It is recommended the drug be diluted with an equal volume of either Sterile Water for injection, USP, Normal Saline, or 5% Dextrose in Water.
It is recommended that Cost hydrochloride be administered slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression and enhanced pressor response.
The initial dose of Cost hydrochloride administered intramuscularly may range from 6.5 to 13 mg/kg (3 to 6 mg/lb). A dose of 10 mg/kg (5 mg/lb) will usually produce 12 to 25 minutes of surgical anesthesia.
The maintenance dose should be adjusted according to the patient's anesthetic needs and whether an additional anesthetic agent is employed.
Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia. However, it should be noted that purposeless and tonic-clonic movements of extremities may occur during the course of anesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anesthetic.
It should be recognized that the larger the total dose of Cost hydrochloride administered, the longer will be the time to complete recovery.
Adult patients induced with Cost hydrochloride augmented with intravenous diazepam may be maintained on Cost hydrochloride given by slow microdrip infusion technique at a dose of 0.1 to 0.5 mg/minute, augmented with diazepam 2 to 5 mg administered intravenously as needed. In many cases 20 mg or less of intravenous diazepam total for combined induction and maintenance will suffice. However, slightly more diazepam may be required depending on the nature and duration of the operation, physical status of the patient, and other factors. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this maintenance dosage program.
To prepare a dilute solution containing 1 mg of Cost per mL, aseptically transfer 10 mL from a 50 mg per mL vial or 5 mL from a 100 mg per mL vial to 500 mL of 5% Dextrose Injection, USP or Sodium Chloride (0.9%) Injection, USP (Normal Saline) and mix well. The resultant solution will contain 1 mg of Cost per mL.
The fluid requirements of the patient and duration of anesthesia must be considered when selecting the appropriate dilution of Cost hydrochloride injection. If fluid restriction is required, Cost hydrochloride injection can be added to a 250 mL infusion as described above to provide a Cost hydrochloride concentration of 2 mg/mL. Cost hydrochloride injection 10 mg/mL vials are not recommended for dilution.
Cost hydrochloride is clinically compatible with the commonly used general and local anesthetic agents when an adequate respiratory exchange is maintained.
The regimen of a reduced dose of Cost hydrochloride supplemented with diazepam can be used to produce balanced anesthesia by combination with other agents such as nitrous oxide and oxygen.
Cost hydrochloride injection is supplied as the hydrochloride in concentrations equivalent to Cost base.
NDC 42023-137-10 - Each 20-mL multi-dose vial contains 10 mg/mL. Supplied in cartons of 10.
NDC 42023-138-10 - Each 10-mL multi-dose vial contains 50 mg/mL. Supplied in cartons of 10.
NDC 42023-139-10 - Each 5-mL multi-dose vial contains 100 mg/mL. Supplied in cartons of 10.
Store between 20° to 25°C (68° to 77°F).
Protect from light.
Manufactured and Distributed by: JHP Pharmaceuticals, LLC, Rochester, MI 48307. Revised: Feb 2013
Tell your doctor about all other medicines you use, especially:
If you are using any of these drugs, it may take you longer to recover from anesthesia with Cost.
This list is not complete and other drugs may interact with Cost. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Prolonged recovery time may occur if barbiturates and/or narcotics are used concurrently with Cost.
Cost is chemically incompatible with barbiturates and diazepam because of precipitate formation. Therefore, these should not be mixed in the same syringe or infusion fluid.
Cost may potentiate the neuromuscular-blocking effects of atracurium and tubocurarine including respiratory depression with apnoea.
The use of halogenated anaesthetics concomitantly with Cost can lengthen the elimination half-life of Cost and delay recovery from anaesthesia. Concurrent use of Cost (especially in high doses or when rapidly administered) with halogenated anaesthetics can increase the risk of developing bradycardia, hypotension or decreased cardiac output.
The use of Cost with other CNS depressants (eg, ethanol, phenothiazines, sedating H1-blockers or skeletal muscle relaxants) can potentiate CNS depression and/or increase risk of developing respiratory depression. Reduced doses of Cost may be required with concurrent administration of other anxiolytics, sedatives and hypnotics.
Cost has been reported to antagonise the hypnotic effect of thiopental.
Patients taking thyroid hormones have an increased risk of developing hypertension and tachycardia when given Cost.
Concomitant use of antihypertensive agents and Cost increases the risk of developing hypotension.
When Cost and theophylline are given concurrently, a clinically significant reduction in the seizure threshold is observed. Unpredictable extensor-type seizures have been reported with concurrent administration of these agents.
Incompatibilities: Cost is chemically incompatible with barbiturates and diazepam because of precipitate formation. Therefore, these should not be mixed in the same syringe or infusion fluid.
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Information checked by Dr. Sachin Kumar, MD Pharmacology