Patient/caregiver was educated on contraindications for using Ryanodex as follows:

  1. Ryanodex use can also result in fast and pounding heartbeat. Individuals with history of cardiac arrhythmias can be at increased risk for precipitation of arrhythmic episodes with ryanodex use and must be increasingly watchful to report worsening symptoms of arrhythmias, such as, chest pain, low blood pressure, confusion, dizziness, increasing shortness of breath, and worsening fatigue.  Hypotension and irregular heartbeat, secondary to ryanodex intake, can contribute to the confusion and dizziness, thus significantly increasing the risk for fall and accidents. Ryanodex could best be avoided for a safer alternative or used with extra caution in individuals with history of life-threatening arrhythmias.
  2. Ryanodex is metabolized inside the body by the liver and is mainly excreted out of the body in the urine by the kidneys. If liver is deficient, metabolism of the drug could be compromised, which can result in higher concentrations of the drug in the body for longer periods of time. If kidney function is deficient, elimination of the drug could be compromised, which also can result in higher concentrations of the drug in the body for longer periods of time. Either case can contribute to toxicity and consequent side-effects. So, for individuals with history of compromised hepatic and/or renal function, ryanodex could either be avoided for a safer alternative or used with caution, with close monitoring for symptoms of toxicity with ryanodex.
  3. Ryanodex can also induce hepatic dysfunction and liver toxicity, leading to fatal liver failure. Individuals can present with symptoms of liver failure, such as, jaundice with yellowing of skin and eyes, itching of skin, upper right abdominal pain, abdominal distension, nausea and vomiting, confusion and disorientation, fluid retention in the body with swelling, and compromised appetite. Ryanodex could best be avoided for a safer alternative or used with extra caution with close watch for signs and symptoms of liver failure in individuals with history of compromised liver function.