dantrolene / Generic mfg. - LARVOL DELTA

Systematic analysis of adverse reactions associated with dantrolene treatment: From clinical features to molecular mechanisms. (PubMed, Medicine (Baltimore)) - "Our study quantified differential dantrolene susceptibility, revealing significantly higher AE risks in MH versus non-MH patients: muscular weakness (ROR: 19.00), respiratory failure (ROR: 5.48), and pulmonary edema (ROR: 22.18). Molecular analysis demonstrated that mutant ryanodine receptor 1 channels amplify IL6/ALB-mediated respiratory effects and disrupt Adgrl1/2-regulated muscle function, establishing the mechanistic basis for MH patient vulnerability and supporting MH-specific dosing strategies."

Journal • Movement Disorders • Musculoskeletal Diseases • Respiratory Diseases • IL6 • RYR1

Dantrolene-Responsive Muscle Stiffness in a Patient With a Normal Neurologic Exam and EMG: A Case Report. (PubMed, Case Rep Neurol Med) - "He was treated with dantrolene and showed marked functional gains that were lost with attempts to wean off medication. This case suggests that there may be a subset of patients suffering from muscle tightness who benefit from dantrolene."

Journal • CNS Disorders • Movement Disorders • Muscular Dystrophy

Suspected Malignant Hyperthermia in a Patient Undergoing Cardiac Surgery: Perioperative Challenges and Management. (PubMed, J Cardiothorac Vasc Anesth) - No abstract available

Journal • Cardiovascular • Metabolic Disorders

National insights on malignant hyperthermia: a SIAARTI survey on clinical practices, preparedness, and future directions. (PubMed, J Anesth Analg Crit Care) - "Our results highlight the need for broader standardization of MH management. Despite limitation in sample size and difference in geographical and hospital setting, the survey reveals a discrepancy between clinical practice and recommended strategies. Although the need for preventive measures as a mean to avoid episodes of MH is widely recognized, there continues to be too much ambiguity on what the exact protocol should be in these situations, leaving room to develop an unequivocal approach that allows the optimal treatment for episodes of MH."

Journal • Anesthesia • Critical care • Genetic Disorders

Intrathecal baclofen use in stiff person syndrome (ASRA-FALL 2025) - "Case: Patient Background •57-year-old male with right auricular melanoma •Previous treatments: partial auriculectomy, sentinel node biopsy, radiotherapy, pembrolizumab •4 years later: fatigue, dizziness, hand tremors Disease Progression and Imaging •Lung nodule → metastatic melanoma confirmed •PET scan: hypermetabolic activity (lung, subcarinal & cervical nodes, adrenal gland) •Labs: eosinophilia •EMG: lower extremity motor neuron/axon injury Symptom Management (Pre-Diagnosis) •Symptoms: generalized pain, cramps, dysphagia, fatigue, disrupted sleep •Medications tried: baclofen, tizanidine, hydrocodone, diazepam, gabapentin, tramadol, prednisone, dantrolene •Partial relief: diazepam (cramps), gabapentin (neuropathic pain) •Physical therapy: aquatic therapy unsuccessful •Oswestry Disability Index (from 0-100): 28 (back; Moderate Disability), 26 (neck; Moderate Disability) Diagnosis and Targeted Therapy •Referred to pain management → diagnosed with Stiff Person Syndrome..."

Late-breaking abstract • CNS Disorders • Eosinophilia • Fatigue • Gastrointestinal Disorder • Immunology • Melanoma • Movement Disorders • Neuralgia • Sleep Disorder • Solid Tumor

Crystal structures of Ryanodine Receptor reveal dantrolene and azumolene interactions guiding inhibitor development. (PubMed, Nat Commun) - "Structure-based screening identifies a potent compound targeting the same site but with a distinct binding mode. Our findings highlight the power of domain-focused crystallography in guiding RyR inhibitor discovery and overcoming cryo-EM resolution limitations."

Journal

Experience of Neuroleptic Malignant Syndrome After Operation:Total Arch Replacement for Stanford Type A Acute Aortic Dissection:Report of a Case (PubMed, Kyobu Geka) - "We discontinued haloperidol and started dantrolene. Neuroleptic malignant syndrome after aortic dissection surgery is very rare and includes numerous differential diagnoses. However, prompt action is important because delays in diagnosis and treatment can lead to deterioration in the general condition of the patient."

Journal • Cardiovascular • Infectious Disease

Dantrolene use across surgical and medical care at Mayo Clinic from 2010 to 2024: Indications, frequency, and value for identifying malignant hyperthermia. (PubMed, Biomol Biomed) - "Dantrolene was administered at an approximate rate of 1 per 10,000 hospital admissions, primarily in oral formulation for chronic spasticity. Among the patients who received perioperative dantrolene, approximately half were confirmed to have MH, resulting in an estimated MH prevalence of 1 in 100,000 patients exposed to general anesthesia."

Journal • Anesthesia • Movement Disorders

Dissolution Profile of Ionizable Drugs in Biorelevant Bicarbonate Buffer at Intermediate Gastrointestinal pH Level. (PubMed, AAPS J) - "For the dissolution tests, febuxostat (FBX), dipyridamole (DPM), dantrolene Na (DNT Na), pioglitazone HCl (PIO HCl), and tosufloxacin tosylate monohydrate (TFLX TS) were employed. The dissolution profiles of ionizable drugs in BCB differed from those in CPB and ACB, especially in the case of the salt-form drugs with an acidic counterion. The floating lid method enables dissolution testing using BCB in the intermediate pH range."

Journal

A Diagnostic Dilemma-Severe Hyperthermia and Rigidity in a Young Man with Polysubstance Use: A Case Report. (PubMed, Clin Pract Cases Emerg Med) - "This case underscores the importance of considering neuroleptic malignant syndrome in patients with atypical presentations, suspicion for comorbid psychiatric conditions, and substance use disorder. Timely diagnosis, discontinuation of the offending agent, and targeted therapies such as dantrolene are critical in preventing complications. We highlight the diagnostic challenges and management strategies for NMS in the context of a limited history and severe hyperthermia."

Journal • Anesthesia • Cardiovascular • CNS Disorders • Critical care • Immunology • Metabolic Disorders • Psychiatry • Schizophrenia • Systemic Inflammatory Response Syndrome

WHEN STOPPING THE DRUG ISN'T ENOUGH: A CURIOUS CASE OF RECURRENT EOSINOPHILIC PLEURAL EFFUSION (CHEST 2025) - "This case highlights the need to consider drug-induced EPE in patients after ruling out more common etiologies. Furthermore, clinicians should be aware that drug-induced pleural effusions may not always resolve after drug cessation and, in some cases, may require procedural intervention. Further research is needed to better understand the mechanisms of dantrolene-induced EPE and identify patients at higher risk for persistent or recurrent effusions."

Clinical • Pleural effusion • Back Pain • Cough • Eosinophilia • Immunology • Infectious Disease • Mood Disorders • Movement Disorders • Musculoskeletal Pain • Pulmonary Disease • Respiratory Diseases • Rheumatology

PROPOFOL OR PROPOFAIL? A CASE OF PROPOFOL-RELATED INFUSION SYNDROME (CHEST 2025) - "Broad-spectrum empiric antibiotics were escalated to meropenem, micafungin and vancomycin...Further clinical decompensation continued with severe hyperthermia of 110.0 degrees Fahrenheit treated with dantrolene and ice water gastric lavage, refractory hypoxia requiring veno-venous extracorporeal membrane oxygenation, refractory distributive shock requiring maximal vasopressor support with norepinephrine, vasopressin, epinephrine, phenylephrine, angiotensin II, stress dose steroids and methylene blue, bradycardia requiring dopamine infusion and temporary intravenous pacemaker placement, acute renal failure requiring continuous renal replacement therapy with severe refractory hyperkalemia despite zero potassium bath, acute liver failure with refractory hypoglycemia, and severe acute rhabdomyolysis with creatine kinase level exceeding 150,000 U/L that had previously plateaued... In conclusion, our case of PRIS highlights both risk factors and syndrome characteristics with..."

Clinical • Acute Kidney Injury • Cardiovascular • CNS Disorders • Hematological Disorders • Hepatology • Hypoglycemia • Hypotension • Infectious Disease • Liver Failure • Metabolic Disorders • Musculoskeletal Diseases • Orthopedics • Renal Disease • Respiratory Diseases • Septic Shock

DOUBLE TROUBLE: CONCURRENT SEROTONIN SYNDROME AND NEUROLEPTIC MALIGNANT SYNDROME (CHEST 2025) - "Bottles of paroxetine and olanzapine were found at the scene...The patient was intubated for airway protection and initiated on intravenous midazolam...Dantrolene for severe muscle rigidity and bromocriptine, a dopamine receptor agonist, are indicated in severe cases of NMS... This case demonstrates the importance of maintaining a high clinical suspicion for both NMS and SS in patients presenting with hyperthermia who are on multiple psychotropic medications. The temporal course of symptoms and response to specific therapies can help distinguish between these syndromes, even when initial presentation is ambiguous."

Cardiovascular • CNS Disorders • Depression • Epilepsy • Heart Failure • Major Depressive Disorder • Mood Disorders • Movement Disorders • Ophthalmology • Psychiatry

SILENT HEAT: UNMASKING MALIGNANT HYPERTHERMIA AFTER CARDIAC ARREST (CHEST 2025) - "This patient's cardiac arrest likely occurred as a consequence of worsening acidosis and hypoxia in the setting of unrecognized MH. Given high fatality if left undiagnosed, early detection of MH is crucial and may lead to sooner initiation of dantrolene and resolution of symptoms. Continued re-evaluation and administration of additional dantrolene is indicated if the patient has residual symptoms after initial dosing."

Anesthesia • Cardiovascular • CNS Disorders • Epilepsy • Metabolic Disorders • Respiratory Diseases • RYR1

Investigation of the cardioprotective potential of dantrolene in mitigating arsenic-induced cardiac dysfunction in rats. (PubMed, Acta Biochim Biophys Sin (Shanghai)) - No abstract available

Journal • Preclinical

A Clinical Trial Utilizing Dantrolene in Patients With Ventricular Arrhythmias. (clinicaltrials.gov) - P2/3 | N=68 | Completed | Sponsor: Vanderbilt University Medical Center | Active, not recruiting ➔ Completed

Trial completion • Cardiovascular • Heart Failure • Ventricular Tachycardia

SILENT HEAT: UNMASKING MALIGNANT HYPERTHERMIA AFTER CARDIAC ARREST (CHEST 2025) - "This patient's cardiac arrest likely occurred as a consequence of worsening acidosis and hypoxia in the setting of unrecognized MH. Given high fatality if left undiagnosed, early detection of MH is crucial and may lead to sooner initiation of dantrolene and resolution of symptoms. Continued re-evaluation and administration of additional dantrolene is indicated if the patient has residual symptoms after initial dosing."

Anesthesia • Cardiovascular • CNS Disorders • Epilepsy • Metabolic Disorders • Respiratory Diseases • RYR1

Atypical Postoperative Presentation of Malignant Hyperthermia in an Elderly Patient Following Transcatheter Aortic Valve Replacement. (PubMed, Cureus) - "Given the patient's atypical age, delayed symptom onset, and notable improvement following dantrolene administration, we present an atypical case in which malignant hyperthermia (MH) could not be ruled out based on clinical progression. This case underscores the importance of maintaining a high index of suspicion for MH in atypical presentations and highlights the critical role of timely diagnosis and intervention."

Journal • Acute Respiratory Distress Syndrome • Anesthesia • Cardiovascular • Hypertension

Impact of Dantrolene on Strength and Respiratory Mechanics - A Clinical Trial (ASA 2025) - "Following ablation but prior to and 10, 20, and 120 minutes after study drug (intravenous dantrolene [Ryanodex] 1mg/kg vs. placebo), we assessed respiratory support, respiratory parameters, arterial blood gas, and electrolytes. Dantrolene reduced skeletal muscle strength and ventilation up to two hours after administration. Escalation of respiratory support was not significantly higher in subjects treated with dantrolene, although a deleterious effect cannot be excluded. Careful monitoring of respiratory function should be undertaken in non-intubated patients treated with dantrolene."

Clinical • Anesthesia • Cardiovascular

Unmasking Malignant Hyperthermia: A Rapid Response to a Hypermetabolic Crisis (ASA 2025) - "Postoperatively, the patient was intubated and received additional dantrolene...The patient recovered uneventfully. This case highlights the diagnostic challenges of hypermetabolic crises in perioperative settings, which require differentiation from similar conditions."

Anesthesia • Cardiovascular

Malignant Hyperthermia: Considerations for Differential Diagnoses (ASA 2025) - "Pertinent home medications included olanzapine, chlorpromazine, valproic acid, trazodone, and carbamazepine. Anesthesia was maintained with sevoflurane and intraoperative course was unremarkable...MH hotline was contacted and dantrolene administration resulted in symptom resolution. Notably, genetic testing confirmed MH susceptibility."

Anesthesia • Cardiovascular • CNS Disorders • Developmental Disorders • Endocrine Disorders • Epilepsy • Immunology • Infectious Disease • Mental Retardation • Movement Disorders • Primary Immunodeficiency • Pulmonary Embolism • Respiratory Diseases • Septic Shock

Suspected Case of Malignant Hyperthermia After Cardiopulmonary Bypass: Diagnosis Supported by Pulmonary Artery Catheter Monitoring (ASA 2025) - "The case highlights how the presence of a PA catheter was key in maintaining high index of clinical suspicion as SvO2 remained low despite normal cardiac function. It also underscores the need to have dantrolene readily available and for providers to be familiar with its preparation."

Clinical • Metabolic Disorders

Near Code After Blocked Endotracheal Tube Misinterpreted as Malignant Hyperthermia (ASA 2025) - "Dantrolene and sodium bicarbonate were administered, resulting in worsened hypercarbia, and the patient neared arrest...Tube exchange resolved the issue. This case highlights the importance of avoiding diagnostic tunnel vision and continuously reassessing evolving clinical data in the setting of inadequate response to treatment."

Anesthesia • Thermal Injury

A Heated Encounter in the MRI Suite: Unmasking Malignant Hyperthermia in a Sepsis-Confounded Case (ASA 2025) - "He initially responded to dantrolene, but his course was complicated by respiratory failure, and he ultimately died from ventilation-related complications. This case illustrates the unpredictable nature of MH, even without prior anesthetic issues, and emphasizes the need for vigilance in remote settings where rapid intervention may be difficult."

Clinical • Anesthesia • Infectious Disease • Respiratory Diseases • Septic Shock

Suspected Malignant Hyperthermia in a 25 year old Male Undergoing Total Thyroidectomy (ASA 2025) - "25-year-old male undergoing total thyroidectomy developed hyperthermia, hypertension, and elevated end-tidal CO₂ one hour following induction with succinylcholine and 30 minutes after exposure to sevoflurane. Hyperthermia was addressed with ice packs and cold intravenous fluids. Postoperatively, the patient was admitted to the intensive care unit where Dantrolene was continued, and endocrinology was consulted."

Anesthesia • Cardiovascular • Endocrine Disorders • Hypertension