Contraindicated in:
Use Cautiously in:
Exercise Extreme Caution in:
CV: atracurium: hypotension.
pancuronium: hypertension.
atracurium, pancuronium: tachycardia.
Derm: rash.
atracurium: skin flushing.
GI: pancuronium: excessive salivation.
Resp: bronchospasm.
Drug-Drug:
Atracurium
(generic available)
Cisatracurium
(generic available)
Pancuronium
(generic available)
Rocuronium
(generic available)
Vecuronium
(generic available)
Atracurium
Cisatracurium
Pancuronium
Rocuronium
Vecuronium
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 2231 min; Pancuronium 2 hr; Rocuronium Infants 312 mo: 0.81.8 hr; Children 13 yr: 0.41.8 hr; Children 38 yr: 0.51.1 hr; Adults: 1.42.4 hr (↑ to 4.3 hr in hepatic impairment and 2.4 hr in renal impairment); Vecuronium Infants: 65 min; Children: 41 min; Adults: 6575 min (↓ near term in pregnant patients, ↑ in hepatic impairment).
ROUTE | ONSET | PEAK | DURATION |
Atracurium IV | 14 min | 35 min | 2035 min |
Cisatracurium IV | 23 min | 35 min | 2850 min |
Pancuronium IV | 3045 sec | 23 min | 4060 min |
Rocuronium IV | 1 min | 0.51 min (peds) 13.7 min (adults) | 2640 min (peds) 31 min (adults)* |
Vecuronium IV | 13 min | 35 min | 3040 min |