Adult Dosing

Neuromuscular Blockade

• Initial Dose: IV 0.4-0.5 mg/kg
• Maintenance dose:
• Intermittent IV: 0.08-0.1 mg/kg q20-45 mins after initial dose, then every 15-25 mins as needed
• Continuous infusion: 5-9 mcg/kg/min (range 2-15 mcg/kg/min) after initial dose, In ICU: 11-13 mcg/kg/min (range 4.5-29.5 mcg/kg/min)

Pediatric Dosing

Neuromuscular Blockade

Child > 2 yrs

• Initial Dose: IV 0.4-0.5 mg/kg
• Maintenance dose:
• Intermittent IV: 0.08-0.1 mg/kg q20-45 mins after initial dose, then every 15-25 mins as needed
• Continuous infusion: 5-9 mcg/kg/min (range 2-15 mcg/kg/min) after initial dose; In ICU: 11-13 mcg/kg/min (range 4.5-29.5 mcg/kg/min)

Neonates, Infants and Children 1 month to < 2 yrs

• Initial Dose under halothane anesesthesia: IV 0.3-0.4 mg/kg
• Note: Doses may be required with slightly greater frequency in infants and children than in adults

[Outline]

• Adult Dosing
• Pediatric Dosing

• As an adjunct to general anesthesia, to facilitate endotracheal intubation
• To provide skeletal muscle relaxation during surgery or mechanical ventilation

• Hypersensitivity to any of the ingredients of the product
• Hypersensitivity to benzyl alcohol (multiple dose vials)

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Small test dose may be used to assess response in patients with neuromuscular diseases such as myasthenia gravis
• Use only under supervision of those skilled in airway management and respiratory support
• Make sure that equipment and personnel are immediately available for endotracheal intubation and support of ventilation, including administration of positive pressure oxygen
• Not for IM administration
• Use only with adequate anesthesia because it has no known effect on consciousness, pain threshold, or cerebration
• Do not mix with alkaline solutions in the same syringe or administered simultaneously during intravenous infusion through the same needle
• The possibility of substantial histamine release in sensitive individuals must be considered as atracurium is a less potent histamine releaser
• Bradycardia during anesthesia may be more common with atracurium than with other muscle relaxants
• Therapy may trigger malignant hyperthermia during anesthesia
• In burn patients, therapy may require increased doses of nondepolarizing muscle relaxants because resistance may develop in burn patients
• The safety of atracurium has not been established in patients with bronchial asthma
• Evaluate benefit-to-risk ratio of neuromuscular block if therapy needed for long-term mechanical ventilation
• Continuously monitor neuromuscular transmission during administration with the help of a nerve stimulator

Cautions: Use cautiously in

• Renal impairment
• Significant hepatic impairment
• Myasthenia gravis
• Cardiovascular disease
• Dehydration or electrolyte abnormalities
• Histamine sensitivity
• Fractures or muscle spasm
• Elderly patients
• Hyperthermia
• Extensive burns and shock
• Low plasma pseudocholinesterase levels
• Obese patients

Pregnancy Category:C

Breastfeeding: Safety Unknown. Manufacturer advises caution while administering to a nursing woman.

• CV: Hypotension, cardiac arrest, arrhythmias, BP changes, increased heart rate
• CNS: Prolonged paralysis, malignant hyperthermia, seizures in ICU patients
• RESP: Respiratory depression, apnea, bronchospasm
• DERM: Flushing
• MISC: Anaphylactic reactions

• Neuromuscular blocking agent-nondepolarizing; blocks the effect of acetylcholine at the myoneural junction resulting in resulting in prevention of neuromuscular transmission
• Metabolized in plasma
• Renally excreted: Major (total > 90% of the labeled dose within 7 hrs of dosing)
• Half-life: 20 mins

US Trade Name(s)

• Only generic available

US Availability

atracurium besylate (generic)

• INJ: 10 mg/mL (5, 10 mL)

Canadian Trade Name(s)

• Only generic available

Canadian Availability

atracurium besylate (generic)

• INJ: 10 mg/mL (5, 10 mL)

UK Trade Name(s)

• Tracrium

UK Availability

atracurium besylate (generic)

• INJ: 10 mg/mL (2.5, 5, 25 mL)

Tracurium

• INJ: 10 mg/mL (2.5, 5, 25 mL)

Australian Trade Name(s)

• Tracrium

Australian Availability

atracurium besylate (generic)

• INJ: 10 mg/mL (2.5, 5 mL)

Tracurium

• INJ: 10 mg/mL (2.5, 5 mL)

[Outline]

Anesthesia

Neuromuscular Blocking Agents