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Indications

High Alert


Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Exercise Extreme Caution in:

Adv. Reactions/Side Effects

CV: atracuriumhypotension, pancuroniumhypertension, atracurium, pancuroniumtachycardia

Derm: rash, atracuriumskin flushing

GI: pancuroniumexcessive salivation

Resp: bronchospasm

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions

Drug-drug:

Availability

Atracurium

(Generic available)

Cisatracurium

(Generic available)

Pancuronium

(Generic available)

Rocuronium

(Generic available)

Vecuronium

(Generic available)

Route/Dosage

Atracurium

Cisatracurium

Pancuronium

Rocuronium

Vecuronium

US Brand Names

atracurium: Tracrium,

cisatracurium: Nimbex,

pancuronium: Pavulon,

rocuronium: Zemuron,

vecuronium: Norcuron

Action

  • Prevent neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. Have no analgesic or anxiolytic properties.
Therapeutic effects:
  • Skeletal muscle paralysis.

Classifications

Therapeutic Classification: neuromuscular blocking agents-nondepolarizing

Pharmacokinetics

Absorption: Following IV administration, absorption is essentially complete.

Distribution: Atracurium—Distributes into extracellular space; crosses the placenta. Cisatracurium—Rapidly distributes into extracellular space.Pancuronium—Rapidly distributes into extracellular fluid; small amounts cross the placenta. Rocuronium—Rapidly distributes into extracellular space.Vecuronium—Rapidly distributes in extracellular fluid; minimal penetration of the CNS.

Metabolism/Excretion: Atracurium—Metabolized in plasma; <5% excreted unchanged in urine. Cisatracurium—Undergoes pH-dependent breakdown, which is responsible for 80% of metabolism; remainder eliminated by liver and kidneys. Pancuronium—Excreted mostly unchanged by the kidneys; small amounts are eliminated in bile. Rocuronium—Mostly metabolized and eliminated by the liver. Vecuronium—Some metabolism by the liver (20%), with conversion to at least one active metabolite; 35% excreted unchanged by the kidneys.

Half-Life: Atracurium—Infants: 20 min; Children: 17 min; Adults: 16 min; Cisatracurium—22–31 min; Pancuronium—2 hr; Rocuronium—Infants 3–12 mo: 0.8–1.8 hr; Children 1–3 yr: 0.4–1.8 hr; Children 3–8 yr: 0.5–1.1 hr; Adults: 1.4–2.4 hr ( to 4.3 hr in hepatic impairment and 2.4 hr in renal impairment); Vecuronium—Infants: 65 min; Children: 41 min; Adults: 65–75 min ( near term in pregnant patients, in hepatic impairment).

Time/Action Profile

(neuromuscular blockade)

ROUTEONSETPEAKDURATION
Atracurium IV1–4 min3–5 min20–35 min
Cisatracurium IV2–3 min3–5 min28–50 min
Pancuronium IV30–45 sec2–3 min40–60 min
Rocuronium IV1 min0.5–1 min (peds) 1–3.7 min (adults)26–40 min (peds) 31 min (adults)*
Vecuronium IV1–3 min3–5 min30–40 min

*Following 0.6 mg/kg dose in adult patients.

Patient/Family Teaching

Pronunciation

atracurium: a-tra-KYOOR-ee-um

cisatracurium: siss-a-tra-KYOOR-ee-um

pancuronium: pan-cure-OH-nee-yum

rocuronium: roe-kyoor-OWN-ee-um

vecuronium: ve-cure-OH-nee-yum