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<meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]">
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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548144_"><span class="title" itemprop="name">Dantrolene</span></h1><p class="fm-aai"><a href="#_NBK548144_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Dantrolene.OVERVIEW"><h2 id="_Dantrolene_OVERVIEW_">OVERVIEW</h2><div id="Dantrolene.Introduction"><h3>Introduction</h3><p>Dantrolene is a muscle relaxant used for treatment of chronic spasticity that differs from other commonly used muscle relaxants in acting peripherally on muscle, rather than centrally on the spinal cord or brain. Dantrolene can cause acute liver injury which can be severe and even fatal.</p></div><div id="Dantrolene.Background"><h3>Background</h3><p>Dantrolene (dan' troe leen) is a lipid soluble diphenylhydantoin analogue that inhibits muscle contractions by decreasing the release of calcium from the sarcoplasmic reticulum in target tissue. Dantrolene is used for the treatment of chronic spasticity and treatment for and prophylaxis against malignant hyperthermia (based upon its ability to block calcium release, which is the initiating event in malignant hyperthermia). Dantrolene was approved for use in the United States in 1974 and is still commonly used for spasticity. Dantrolene is available as capsules of 25, 50 and 100 mg in several generic forms and under the commercial name Dantrium. In adults, the recommended initial dose for spasticity is 25 mg daily, with subsequent increases to a dose of 25 to 100 mg three times daily. Dantrolene is also available in parenteral formulations for therapy of acute episodes of malignant hyperthermia; the recommended initial dose being 1 mg/kg intravenously. For prophylaxis against hyperthermia, dantrolene is given orally in doses of 4 to 8 mg/kg daily. Common side effects include weakness, nausea, drowsiness, fatigue and dizziness.</p></div><div id="Dantrolene.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Mild, asymptomatic serum aminotransferase elevations during dantrolene therapy are relatively uncommon (1%), but clinically over liver injury is estimated to occur in 1 to 2 per thousand treated persons (0.1% to 0.2%). The liver injury can be severe; cases of acute liver failure and even death have been described (Case 1). The latency to onset of clinically apparent liver injury ranges from one week to several months, but is usually within the first 6 months of starting therapy (Case 2). More serious cases are associated with a sudden onset with jaundice, nausea and fatigue, and rapid progression. Allergic manifestations such as fever, rash and eosinophilia are rare, as are autoimmune features. The pattern of enzyme elevations is predominantly hepatocellular. Liver histology demonstrates an acute-hepatitis like picture. Recovery is usually complete within 1 to 3 months. Women, the elderly, and patients taking higher doses appear to be more susceptible to developing dantrolene hepatotoxicity.</p><p>Likelihood score: A (Well established cause of clinically apparent liver injury).</p></div><div id="Dantrolene.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>Dantrolene is structurally similar to phenytoin, which is a well known cause of idiosyncratic acute liver injury; thus, two agents may share a similar mechanism of hepatic injury. However, dantrolene rarely causes immunoallergic hepatitis (which is typical of phenytoin) and cases of more severe injury are associated with taking higher doses of dantrolene, suggesting the presence of a toxic metabolite.</p></div><div id="Dantrolene.Outcome_and_Management"><h3>Outcome and Management</h3><p>Cases of acute hepatitis with jaundice due to dantrolene can be severe and even fatal; however, most cases are followed by complete recovery within 1 to 3 months of stopping the medication. Cases of chronic hepatitis or bile duct vanishing syndrome have not been reported. Rechallenge results in recurrence and should be avoided. There is at least a theoretical concern of cross sensitivity with phenytoin, but other drugs for spasticity should be tolerated without recurrence of liver injury.</p><p>Drug Class: <a href="/books/n/livertox/MuscleRelaxants/?report=reader">Muscle Relaxants</a></p></div></div><div id="Dantrolene.CASE_REPORTS"><h2 id="_Dantrolene_CASE_REPORTS_">CASE REPORTS</h2><div id="Dantrolene.Case_1._Fatal_progressive_liv"><h3>Case 1. Fatal progressive liver disease after a 12 week course of dantrolene.</h3><p>[Modified from: Cornette M, Gillard C, Borlee-Hermans G. (Fatal toxic hepatitis associated with administration of dantrolene.) Acta Neurol Belg 1980; 80: 336-47. French. <a href="https://www.ncbi.nlm.nih.gov/pubmed/7468146" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a>]</p><p>A 50 year old woman with diabetes and multiple sclerosis was given dantrolene for spasticity and developed jaundice 12 weeks later. She began complaining of nausea, poor appetite, and weight loss after 7 weeks of therapy, but dantrolene was continued and she had lost 13 kilograms of weight and developed jaundice before the drug was stopped. She had no history of liver disease or exposure to hepatitis and did not drink alcohol. On admission, she was mildly jaundiced and laboratory tests showed mild elevations in serum ALT and alkaline phosphatase (Table). There was no fever or rash. Tests for viral hepatitis and autoantibodies were negative. Cholangiography was negative as was a CT scan of the liver. Nevertheless, she underwent exploratory laparotomy. Intraoperative liver biopsy showed intrahepatic cholestasis and mixed cellular injury suggestive of drug induced liver disease. She deteriorated postoperatively with progressive jaundice, ascites, and hepatic encephalopathy, dying of multiorgan failure 2 weeks after surgery.</p><div id="Dantrolene.Key_Points1"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figDantroleneT1"><a href="/books/NBK548144/table/Dantrolene.T1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobDantroleneT1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="Dantrolene.T1"><a href="/books/NBK548144/table/Dantrolene.T1/?report=objectonly" target="object" rid-ob="figobDantroleneT1">Table</a></h4></div></div></div><div id="Dantrolene.Laboratory_Values1"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figDantroleneT2"><a href="/books/NBK548144/table/Dantrolene.T2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobDantroleneT2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="Dantrolene.T2"><a href="/books/NBK548144/table/Dantrolene.T2/?report=objectonly" target="object" rid-ob="figobDantroleneT2">Table</a></h4></div></div></div><div id="Dantrolene.Comment1"><h4>Comment</h4><p>This patient was continued on dantrolene despite symptoms of liver disease for several weeks and, perhaps as a consequence, had a progressive downhill course with worsening jaundice and hepatic synthetic dysfunction. Also unfortunate, was the unnecessary laparotomy and general anesthesia which may have worsened the liver injury. Somewhat unusual in this case was the minimal elevations in serum ALT at presentation, but there may have been more marked elevations earlier in the symptomatic course before clinical evaluation.</p></div></div><div id="Dantrolene.Case_2._Acute_hepatitis_from_"><h3>Case 2. Acute hepatitis from dantrolene with recurrence on rechallenge.</h3><p>[Modified from: Ogburn RM, Myers RL, Burdick GE. Hepatitis associated with dantrolene sodium. Ann Intern Med 1976; 84: 53-4. <a href="https://www.ncbi.nlm.nih.gov/pubmed/1244796" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a>]</p><p>A 26 year old man with Friedreich's ataxia with spasticity and dysarthria was started on dantrolene in a dose of 25 mg four times daily. After 10 days, his dysarthria worsened and dantrolene was stopped. Serum enzymes were reported to be normal. One year later, dantrolene was restarted and he again experienced worsening dysarthria and stopped the medication after 10 days. Over the course of the following month, he had the insidious onset of malaise, nausea, dark urine and light stools. When found to be jaundiced, he was admitted for evaluation. He denied a history of liver disease and exposure to viral hepatitis or other toxins. Total bilirubin was 4.6 mg/dL, AST 740 U/L, but alkaline phosphatase was normal (Table). Tests for viral hepatitis and autoantibodies were negative. He had no rash, fever or eosinophilia. He improved rapidly and was discharged. Two months after recovering, he was restarted on dantrolene by another physician. His dysarthria worsened and, for the third time, he stopped the medication after 10 days. The day after stopping therapy, serum AST was 115 U/L and bilirubin was slightly elevated. During the next few weeks, he developed clinically apparent acute liver injury and was admitted. Laboratory tests again showed no evidence of viral hepatitis or autoimmune liver condition. A liver biopsy showed an acute hepatitis-like picture with prominence of eosinophils in portal areas. Over the next two weeks, the patient recovered and was discharged. Two weeks later he was clinically well and serum AST had fallen to 96 U/L.</p><div id="Dantrolene.Key_Points2"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figDantroleneT3"><a href="/books/NBK548144/table/Dantrolene.T3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobDantroleneT3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="Dantrolene.T3"><a href="/books/NBK548144/table/Dantrolene.T3/?report=objectonly" target="object" rid-ob="figobDantroleneT3">Table</a></h4></div></div></div><div id="Dantrolene.Laboratory_Values2"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figDantroleneT4"><a href="/books/NBK548144/table/Dantrolene.T4/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobDantroleneT4"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="Dantrolene.T4"><a href="/books/NBK548144/table/Dantrolene.T4/?report=objectonly" target="object" rid-ob="figobDantroleneT4">Table</a></h4></div></div></div><div id="Dantrolene.Comment2"><h4>Comment</h4><p>The recurrence of an acute hepatitis-like syndrome with rechallenge and similarity of the two episodes with a shortening of the latency on second exposure is strongly supportive of the role of dantrolene in causing the acute hepatitis-like liver injury. Somewhat unusual was the worsening of the liver injury for several weeks after dantrolene was stopped. Dantrolene, by inhibiting calcium release from the sarcoplasmic reticulum, can also cause generalized weakness which may account for the dysarthria that this patient experienced with each exposure to dantrolene. By limiting the duration of therapy, the dysarthria probably spared him a more severe hepatic injury.</p></div></div></div><div id="Dantrolene.PRODUCT_INFORMATION_Muscle_Re"><h2 id="_Dantrolene_PRODUCT_INFORMATION_Muscle_Re_">PRODUCT INFORMATION</h2><div id="Dantrolene.BPI" class="box boxed-text-box whole_rhythm hide-overflow"><p>
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<b> REPRESENTATIVE TRADE NAMES</b>
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</p><p>Dantrolene – Generic, Dantrium®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Autonomic Agents: Muscle Relaxants, Central</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=dantrolene" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri"> COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></div><div id="Dantrolene.CHEMICAL_FORMULA_AND_STRUCTUR"><h2 id="_Dantrolene_CHEMICAL_FORMULA_AND_STRUCTUR_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figDantroleneT5"><a href="/books/NBK548144/table/Dantrolene.T5/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobDantroleneT5"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="Dantrolene.T5"><a href="/books/NBK548144/table/Dantrolene.T5/?report=objectonly" target="object" rid-ob="figobDantroleneT5">Table</a></h4></div></div></div><div id="Dantrolene.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Dantrolene_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 30 January 2017</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Dantrolene.R1">Zimmerman HJ. Muscle spasmolytics. In, Hepatotoxicity: The Adverse Effects of Drugs and Other Chemicals on the Liver. 2nd Ed. Philadelphia: Lippincott, 1999. p. 544-45.<div><i>(Expert review of hepatotoxicity published in 1999 mentions that dantrolene causes overt liver injury in 0.4% of recipients, which is usually hepatocellular and sometimes fatal).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R2">Chyatte SB, Birdsong JH. The use of dantrolene sodium in disorders of the central nervous system. South Med J 1971; 64: 830-4.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/4933014" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4933014</span></a>]<div><i>(Among 30 patients treated with dantrolene long term, 3 developed transient AST elevations but none were considered clinically significant).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R3">Herman R, Mayer N, Mecomber SA. Clinical pharmaco-physiology of dantrolene sodium. Am J Phys Med 1972; 51: 296-311.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/4564128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4564128</span></a>]<div><i>(Study of effects of dantrolene on neuromuscular activity in humans; no mention of adverse effects).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R4">Mayer N, Necomber SA, Herman R. Treatment of spasticity with dantrolene sodium. Am J Phys Med 1973; 52:18-29.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/4685519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4685519</span></a>]<div><i>(A study of efficacy and safety of dantrolene; one patient with alcoholic cirrhosis had mild ALT and AST elevations that resolved with stopping and recurred with restarting drug).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R5">Joynt RL. Dantrolene sodium: long-term effects in patients with muscle spasticity. Arch Phys Med Rehabil 1976; 57: 212-7.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/776122" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 776122</span></a>]<div><i>(Among 77 patients treated with dantrolene for up to 2 years, 3 had AST elevations and one developed jaundice after 2 months and died one week later apparently of liver failure).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R6">Ogburn RM, Myers RL, Burdick GE. Letter: Hepatitis associated with dantrolene sodium. Ann Intern Med 1976; 84: 53-4.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/1244796" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1244796</span></a>]<div><i>(26 year old man developed acute hepatitis like syndrome 43 days after starting dantrolene [bilirubin 4.6 mg/dL, ALT 740 U/L, Alk P 106 U/L], resolving in a few weeks; recurrence with latency of 11 days on reexposure [Case 2]).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R7">Schneider R, Mitchell D. Dantrolene hepatitis. JAMA 1976; 235:1590-1.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/946274" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 946274</span></a>]<div><i>(38 year old woman with spasticity developed jaundice 16 weeks after starting escalating doses of dantrolene [bilirubin 9.0 rising to 32.8 mg/dL, AST 258 U/L, Alk P 215 U/L], resolving within 3 months of stopping).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R8">Assatourians P. Dantrolene hepatitis. JAMA 1976; 236: 1351.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/989080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 989080</span></a>]<div><i>(Letter in response to Schneider [1976] arguing that a liver biopsy rather than ERCP was the diagnostic procedure of choice: "Any student of hepatology knows...").</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R9">Pinder RM, Brogden RN, Speight TM, Avery GS. Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs 1977; 13: 3-23.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/318989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 318989</span></a>]<div><i>(Review of efficacy and safety of dantrolene; minor abnormalities in AST occur in 10% of patients and hepatitis in 0.35-0.5%).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R10">Utili R, Boitnott JK, Zimmerman HJ. Dantrolene-associated hepatic injury. Incidence and character. Gastroenterology 1977; 72 (4 Pt 1): 610-6.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/838213" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 838213</span></a>]<div><i>(A study of dantrolene safety based upon 2191 patients treated for at least 60 days; 1.8% developed evidence of hepatic injury, 0.6% jaundice and 0.3% died: about 1% had to stop due to hepatotoxicity and 2 of 5 who were restarted had a recurrence; recovery time ranged from 1 to 12 months and women were more likely to have liver injury than men; analysis of ~30,000 patients taking long term dantrolene revealed 31 physician reported cases of hepatoxicity [0.1%], 16 [52%] being jaundiced and 11 [35%] fatal).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R11">Wilkinson SP, Portmann B, Williams R. Hepatitis from dantrolene sodium. Gut 1979; 20: 33-6.
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[<a href="/pmc/articles/PMC1418951/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1418951</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/761834" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 761834</span></a>]<div><i>(Description of 1 man and 3 women [ages 45 to 80 years] who developed hepatotoxicity 1 to 3 months after starting dantrolene [bilirubin normal to 19 mg/dL, AST 137 to 800 U/L, Alk P 117 to 345 U/L], liver biopsy revealed acute hepatitis with focal or bridging necrosis, recovery in 4 to 12 weeks).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R12">Cornette M, Gillard C, Borlee-Hermans G. [Fatal toxic hepatitis associated with administration of dantrolene (author's transl)] Acta Neurol Belg 1980; 80: 336-47. French.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/7468146" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7468146</span></a>]<div><i>(50 year old woman developed nausea, weight loss, and jaundice 3 months after starting dantrolene [bilirubin 2.0 rising to 35 mg/dL, ALT 57-214 U/L and Alk P 175-414 U/L], undergoing cholecystectomy and dying of sepsis and shock several days later [Case 1]).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R13">Arnold TH Jr, Epps JM 3rd, Cook HR, Hamrick ME. Dantrolene sodium: urinary metabolites and hepatotoxicity. Res Commun Chem Pathol Pharmacol 1983; 39: 381-98.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6856946" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6856946</span></a>]<div><i>(Animal study showing dose related hepatotoxicity of dantrolene in mice).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R14">Durham JA, Gandolfi AJ, Bentley JB. Hepatotoxicological evaluation of dantrolene sodium. Drug Chem Toxicol 1984; 7: 23-40.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6723545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6723545</span></a>]<div><i>(Animal study showing no hepatotoxicity of dantrolene in mice).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R15">Sorensen EM, Acosta D. Comparison of dantrolene sodium with erythromycin estolate using primary cultures of rat hepatocytes. Drug Chem Toxicol 1985; 8: 219-37.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/4075997" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4075997</span></a>]<div><i>(Erythromycin, but not dantrolene, caused injury to primary rat hepatocytes).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R16">Chan CH. Dantrolene sodium and hepatic injury. Neurology. 1990; 40: 1427-32.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/2392230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2392230</span></a>]<div><i>(Review of 122 cases of dantrolene hepatotoxicity reported to manufacturer; 59 with symptoms, 36 jaundice and 27 fatal; most arising within first 6 months, but fatal cases often late; mean ALT 784 U/L, Alk P 2-3 times ULN).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R17">Tolman KG. Hepatotoxicity of antirheumatic drugs. J Rheumatol Suppl 1990; 22: 6-11.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/2192059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2192059</span></a>]<div><i>(Review of hepatotoxicity of antirheumatic drugs including dantrolene).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R18">Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage 2004; 28: 140-75.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/15276195" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15276195</span></a>]<div><i>(Thorough review of the pharmacology, efficacy and side effects of the muscle relaxants).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R19">Russo MW, Galanko JA, Shrestha R, Fried MW, Watkins P. Liver transplantation for acute liver failure from drug-induced liver injury in the United States. Liver Transpl 2004; 10: 1018-23.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/15390328" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15390328</span></a>]<div><i>(Among ~50,000 liver transplants done in the US between 1990 and 2002, 270 [0.5%] were done for drug induced acute liver failure, but none were attributed to dantrolene or other muscle relaxants).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R20">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J; Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008; 135: 1924-34.
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[<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div><i>(Among 300 cases of drug induced liver disease in the US collected from 2004 to 2008, one was attributed to chlorzoxazone, but none to dantrolene or other muscle relaxants).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R21">Reuben A, Koch DG, Lee WM; Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology 2010; 52: 2065-76.
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[<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div><i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, none of which were attributed to dantrolene).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R22">Kim JY, Chun S, Bang MS, Shin HI, Lee SU. Safety of low-dose oral dantrolene sodium on hepatic function. Arch Phys Med Rehabil 2011; 92: 1359-63.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/21878205" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21878205</span></a>]<div><i>(Retrospective analysis of liver test results from 243 patients treated with dantrolene for 4 weeks or more; one patient, an HBsAg carrier, developed elevations in liver tests without symptoms 82 days after starting dantrolene [bilirubin rising from 0.5 to 2.5 mg/dL, AST 54 to 85 U/L, Alk P 167 to 245 U/L], which resolved on stopping).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R23">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology 2013 ; 144: 1419-25.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div><i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, but none were attributed to dantrolene or other muscle relaxants).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R24">Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America. An analysis of published reports. Ann Hepatol 2014; 13: 231-9.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div><i> (Systematic review of literature of drug induced liver injury in Latin American countries published from 1996 to 2012 identified 176 cases, none of which were attributed to dantrolene or other muscle relaxants).</i></div></div></li><li><div class="bk_ref" id="Dantrolene.R25">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology 2015; 148: 1340-1352.e7.
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[<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div><i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 5 [0.7%] were attributed to muscle relaxants including 2 to dantrolene).</i></div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548144_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">January 30, 2017</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Dantrolene. [Updated 2017 Jan 30].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Dalfampridine/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/Daprodustat/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobDantroleneT1"><div id="Dantrolene.T1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548144/table/Dantrolene.T1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Dantrolene.T1_lrgtbl__"><table><thead><tr><th id="hd_h_Dantrolene.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Medication:</th><td rowspan="1" colspan="1" style="vertical-align:top;">Dantrolene (400 mg daily)</td></tr></thead><tbody><tr><th headers="hd_h_Dantrolene.T1_1_1_1_1" id="hd_b_Dantrolene.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Pattern:</th><td headers="hd_b_Dantrolene.T1_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Mixed (R=~2.1)</td></tr><tr><th headers="hd_h_Dantrolene.T1_1_1_1_1" id="hd_b_Dantrolene.T1_1_1_2_1" rowspan="1" colspan="1" style="vertical-align:top;">Severity:</th><td headers="hd_b_Dantrolene.T1_1_1_2_1" rowspan="1" colspan="1" style="vertical-align:top;">5+ (death)</td></tr><tr><th headers="hd_h_Dantrolene.T1_1_1_1_1" id="hd_b_Dantrolene.T1_1_1_3_1" rowspan="1" colspan="1" style="vertical-align:top;">Latency:</th><td headers="hd_b_Dantrolene.T1_1_1_3_1" rowspan="1" colspan="1" style="vertical-align:top;">95 days</td></tr><tr><th headers="hd_h_Dantrolene.T1_1_1_1_1" id="hd_b_Dantrolene.T1_1_1_4_1" rowspan="1" colspan="1" style="vertical-align:top;">Recovery:</th><td headers="hd_b_Dantrolene.T1_1_1_4_1" rowspan="1" colspan="1" style="vertical-align:top;">None</td></tr><tr><th headers="hd_h_Dantrolene.T1_1_1_1_1" id="hd_b_Dantrolene.T1_1_1_5_1" rowspan="1" colspan="1" style="vertical-align:top;">Other medications:</th><td headers="hd_b_Dantrolene.T1_1_1_5_1" rowspan="1" colspan="1" style="vertical-align:top;">Not mentioned</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobDantroleneT2"><div id="Dantrolene.T2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548144/table/Dantrolene.T2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Dantrolene.T2_lrgtbl__"><table><thead><tr><th id="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Time After Starting</th><th id="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">Time After Stopping</th><th id="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">ALT (U/L)</th><th id="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">Alk P (U/L)</th><th id="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">Bilirubin (mg/dL)</th><th id="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Other</th></tr></thead><tbody><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">-1 month</td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">20</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">75</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">0.5</td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">0</td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_3 hd_h_Dantrolene.T2_1_1_1_4 hd_h_Dantrolene.T2_1_1_1_5 hd_h_Dantrolene.T2_1_1_1_6" colspan="4" rowspan="1" style="vertical-align:top;">Start Dantrolene</td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">1 month</td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">33</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">147</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">2 months</td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Onset of symptoms</td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">3 months</td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">0</td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">57</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">175</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">2.0</td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Jaundice, dantrolene stopped</td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">17 days</td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">73</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">135</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">9.0</td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Exploratory laparotomy</td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">24 days</td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">214</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">123</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">25.0</td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Ascites, encephalopathy</td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">31 days</td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">159</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">414</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">35.0</td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">4 months</td><td headers="hd_h_Dantrolene.T2_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">32 days</td><td headers="hd_h_Dantrolene.T2_1_1_1_3 hd_h_Dantrolene.T2_1_1_1_4 hd_h_Dantrolene.T2_1_1_1_5 hd_h_Dantrolene.T2_1_1_1_6" colspan="4" rowspan="1" style="vertical-align:top;">Death</td></tr><tr><td headers="hd_h_Dantrolene.T2_1_1_1_1 hd_h_Dantrolene.T2_1_1_1_2" colspan="2" rowspan="1" style="vertical-align:top;">
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<b>Normal Values</b>
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</td><td headers="hd_h_Dantrolene.T2_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><42</b>
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</td><td headers="hd_h_Dantrolene.T2_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><115</b>
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</td><td headers="hd_h_Dantrolene.T2_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><1.2</b>
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</td><td headers="hd_h_Dantrolene.T2_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobDantroleneT3"><div id="Dantrolene.T3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548144/table/Dantrolene.T3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Dantrolene.T3_lrgtbl__"><table><thead><tr><th id="hd_h_Dantrolene.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Medication:</th><td rowspan="1" colspan="1" style="vertical-align:top;">Dantrolene (100 mg daily)</td></tr></thead><tbody><tr><th headers="hd_h_Dantrolene.T3_1_1_1_1" id="hd_b_Dantrolene.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Pattern:</th><td headers="hd_b_Dantrolene.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Hepatocellular (ALT without Alk P elevations)</td></tr><tr><th headers="hd_h_Dantrolene.T3_1_1_1_1" id="hd_b_Dantrolene.T3_1_1_2_1" rowspan="1" colspan="1" style="vertical-align:top;">Severity:</th><td headers="hd_b_Dantrolene.T3_1_1_2_1" rowspan="1" colspan="1" style="vertical-align:top;">3+ (jaundice, hospitalization)</td></tr><tr><th headers="hd_h_Dantrolene.T3_1_1_1_1" id="hd_b_Dantrolene.T3_1_1_3_1" rowspan="1" colspan="1" style="vertical-align:top;">Latency:</th><td headers="hd_b_Dantrolene.T3_1_1_3_1" rowspan="1" colspan="1" style="vertical-align:top;">Initially, ~33 days from starting, 23 days after stopping the drug. On rechallenge, ~11 days from starting, 1 day after stopping</td></tr><tr><th headers="hd_h_Dantrolene.T3_1_1_1_1" id="hd_b_Dantrolene.T3_1_1_4_1" rowspan="1" colspan="1" style="vertical-align:top;">Recovery:</th><td headers="hd_b_Dantrolene.T3_1_1_4_1" rowspan="1" colspan="1" style="vertical-align:top;">Complete</td></tr><tr><th headers="hd_h_Dantrolene.T3_1_1_1_1" id="hd_b_Dantrolene.T3_1_1_5_1" rowspan="1" colspan="1" style="vertical-align:top;">Other medications:</th><td headers="hd_b_Dantrolene.T3_1_1_5_1" rowspan="1" colspan="1" style="vertical-align:top;">None mentioned</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobDantroleneT4"><div id="Dantrolene.T4" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548144/table/Dantrolene.T4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Dantrolene.T4_lrgtbl__"><table><thead><tr><th id="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Time After Starting</th><th id="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">Time After Stopping</th><th id="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">ALT (U/L)</th><th id="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">Alk P (U/L)</th><th id="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">Bilirubin (mg/dL)</th><th id="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Other</th></tr></thead><tbody><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">10 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">0</td><td headers="hd_h_Dantrolene.T4_1_1_1_3 hd_h_Dantrolene.T4_1_1_1_4 hd_h_Dantrolene.T4_1_1_1_5 hd_h_Dantrolene.T4_1_1_1_6" colspan="4" rowspan="1" style="vertical-align:top;">Dantrolene stopped due to dysarthria</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">33 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">23 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_3 hd_h_Dantrolene.T4_1_1_1_4 hd_h_Dantrolene.T4_1_1_1_5 hd_h_Dantrolene.T4_1_1_1_6" colspan="4" rowspan="1" style="vertical-align:top;">Malaise, nausea, vomiting, pale stools</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">42 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">32 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">740</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">106</td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">4.6</td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Jaundice</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">43 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">34 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">500</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Discharged</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">68 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">58 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">52</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">1.6</td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">
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<b>Time After Restarting</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
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<b>Time After Stopping Again</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
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<b>ALT (U/L)</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<b>Alk P (U/L)</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
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<b>Bilirubin (mg/dL)</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">
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<b>Dantolene Restarted</b>
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</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">10 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">0</td><td headers="hd_h_Dantrolene.T4_1_1_1_3 hd_h_Dantrolene.T4_1_1_1_4 hd_h_Dantrolene.T4_1_1_1_5 hd_h_Dantrolene.T4_1_1_1_6" colspan="4" rowspan="1" style="vertical-align:top;">Dantrolene stopped because of worsening dysarthria</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">11 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">1 day</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">115</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">2.1</td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Jaundice</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">24 days</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">2 weeks</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">1150</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">4.5</td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Acute hepatitis like symptoms</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">4 weeks</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">3 weeks</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;">Biopsy</td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">6 weeks</td><td headers="hd_h_Dantrolene.T4_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">5 weeks</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">96</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;"></td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td headers="hd_h_Dantrolene.T4_1_1_1_1 hd_h_Dantrolene.T4_1_1_1_2" colspan="2" rowspan="1" style="vertical-align:top;">
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<b>Normal Values</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><42</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><115</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
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<b><1.2</b>
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</td><td headers="hd_h_Dantrolene.T4_1_1_1_6" rowspan="1" colspan="1" style="vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="boxed-text" id="figobDantroleneBPI"><div id="Dantrolene.BPI" class="box boxed-text-box whole_rhythm hide-overflow"><p>
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<b> REPRESENTATIVE TRADE NAMES</b>
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</p><p>Dantrolene – Generic, Dantrium®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Autonomic Agents: Muscle Relaxants, Central</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=dantrolene" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri"> COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></article><article data-type="table-wrap" id="figobDantroleneT5"><div id="Dantrolene.T5" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548144/table/Dantrolene.T5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Dantrolene.T5_lrgtbl__"><table><thead><tr><th id="hd_h_Dantrolene.T5_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">DRUG</th><th id="hd_h_Dantrolene.T5_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">CAS REGISTRY NO</th><th id="hd_h_Dantrolene.T5_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Dantrolene.T5_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Dantrolene.T5_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Dantrolene</td><td headers="hd_h_Dantrolene.T5_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134987695" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">7261-97-4</a>
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</td><td headers="hd_h_Dantrolene.T5_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">C14-H10-N4-O5</td><td headers="hd_h_Dantrolene.T5_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
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<div class="graphic"><img src="/books/NBK548144/bin/Dantrolene_Structure.jpg" alt="Dantrolene chemical structure" /></div>
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