Atracurium

Atracurium

[$6.03 per vial]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Tracurium

ICU INDICATIONS:

  1. Muscle Relaxant

PRESENTATION AND ADMINISTRATION:

  • IV:
    50mg in 5ml solution
    Administer neat for IV injection or infusion
    Compatible with the following IV fluids:
    Normal saline, 5% dextrose, dextrose and sodium chloride, Hartmanns [NOTE: only compatible in Hartmanns for 4 hours therefore do not use by infusion]
    Tracrium is a sterile, non-pyrogenic aqueous solution. Each ml contains 10 mg atracurium besylate.
    Atracurium besylate slowly loses potency with time at the rate of approximately 6%/year under refrigeration. Atracurium besylate should be refrigerated at 2-8°C to preserve potency. Rate of loss in potency increases to approximately 5%/ month at 25°C.
    Upon removal from refrigeration to room temperature storage conditions, use atracurium besylate within 14 days even if re-refrigerated.

DOSAGE:

  • IV:
    0.3-0.6mg/kg stat (usually give 50mg) then 0.1-0.2mg/kg when required or 5-9mcg/kg/min

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV:
    0.3-0.6mg/kg stat then 0.1-0.2mg/kg when required or 5-10mcg/kg/min

CLINICAL PHARMACOLOGY:

  • Atracurium besylate is an intermediate-duration, nondepolarizing, skeletal muscle relaxant. Elimination of atracurium is not dependent on renal clearance mechanisms and no dose adjustment is required in renal impairment

CONTRAINDICATIONS:

  1. hypersensitivity to atracurium

WARNINGS

  • Although atracurium besylate is a less potent histamine releaser than d-tubocurarine or metocurine, the possibility of substantial histamine release in sensitive individuals must be considered. Special caution should be exercised in administering atracurium besylate to patients in whom substantial histamine release would be especially hazardous (e.g., patients with clinically significant cardiovascular disease) and in patients with any history (e.g., severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release.

PRECAUTIONS

  • General:
    Atracurium besylate may have profound effects in patients with myasthenia gravis, Eaton-Lambert syndrome, or other neuromuscular diseases in which potentiation of nondepolarizing agents has been noted. The use of a peripheral nerve stimulator is especially important for assessing neuromuscular block in these patients.
    When there is a need for long-term mechanical ventilation, the benefits-to-risk ratio of neuromuscular block must be considered. Little information is available on the plasma levels and clinical consequences of atracurium metabolites that may accumulate during days to weeks of atracurium administration in ICU patients. Laudanosine, a major biologically active metabolite of atracurium without neuromuscular blocking activity, produces transient hypotension and, in higher doses, cerebral excitatory effects (generalized muscle twitching and seizures) when administered to several species of animals. There have been rare spontaneous reports of seizures in ICU patients who have received atracurium or other agents.
  • Laboratory Tests:
    No tests additional to routine ICU tests are required
  • Drug/Laboratory Test Interactions:
    None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Drugs which may enhance the neuromuscular blocking action of atracurium besylate include: certain antibiotics, especially the aminoglycosides and polymyxins; lithium; magnesium salts; procainamide; and quinidine. The prior administration of succinylcholine does not enhance the duration, but quickens the onset and may increase the depth, of neuromuscular block induced by atracurium besylate.

ADVERSE REACTIONS

  • General:
    Allergic reactions (anaphylactic or anaphylactoid responses) which, in rare instances, were severe (e.g., cardiac arrest). Musculoskeletal: Inadequate block, prolonged block.
  • Cardiovascular:
    Hypotension, vasodilatation (flushing), tachycardia, bradycardia.
  • Respiratory:
    Dyspnea, bronchospasm, laryngospasm.
  • Integumentary:
    Rash, urticaria, reaction at injection site.

Critical Care Drug Manual

Print Friendly