Atracurium besylate
Atracurium besylate (Tracrium Injection)
Atracurium besylate
(ah-trah- KYOUR-ee-um)
Pregnancy Category: C Tracrium Injection (Rx)

Classification: Nondepolarizing skeletal muscle relaxant

See Also: See also Neuromuscular Blocking Agents.

Action/Kinetics: Prevents the action of acetylcholine by competing for the cholinergic receptor at the motor end plate. It may also release histamine, leading to hypotension. Onset: Within 2 min. Peak effect: 1-2 min. Duration: 20-40 min with balanced anesthesia. Recovery from blockade under balanced anesthesia begins about 20-35 min after injection; recovery is usually 95% complete within 60-70 min after injection. t 1/2: 20 min. Recovery occurs more rapidly than recovery from d-tubocurarine, metocurine, and pancuronium. Metabolized in the plasma.

Uses: Skeletal muscle relaxant during surgery; adjunct to general anesthesia; assist in ET intubation. Investigational: Treat seizures due to drugs or electrically induced.

Contraindications: In clients with myasthenia gravis, Eaton-Lambert syndrome, electrolyte disorders, bronchial asthma.

Special Concerns: Use with caution during labor and delivery and when significant histamine release would be dangerous (e.g., CV disease, asthma). Safety and efficacy have not been determined during lactation. Children up to 1 month of age may be more sensitive to the effects of atracurium. No known effect on pain threshold or consciousness; use only with adequate anesthesia.

Additional Side Effects: CV: Flushing, tachycardia. Dermatologic: Rash, urticaria, reaction at injection site. Musculoskeletal: Prolonged block, inadequate block. Respiratory: Dyspnea, laryngospasm. Hypersensitivity: Allergic reactions. Other side effects may be due to histamine release and include flushing, erythema, wheezing, urticaria, bronchial secretions, BP and HR changes.

Overdose Management: Symptoms: Hypotension, enhanced pharmacologic effects. Treatment: CV support. Ensure airway and ventilation. An anticholinesterase reversing agent (e.g., neostigmine, edrophonium, pyridostigmine) with an anticholinergic agent (e.g., atropine, glycopyrrolate) may be used.

Additional Drug Interactions: Acetylcholinesterase inhibitors / Muscle relaxation is inhibited and neuromuscular block is reversed Aminoglycosides / Muscle relaxation Corticosteroids / Prolonged weakness Enflurane / Muscle relaxation Halothane / Muscle relaxation Isoflurane / Muscle relaxation Lithium / Muscle relaxation Phenytoin / Effect of atracurium Procainamide / Muscle relaxation Quinidine / Muscle relaxation Succinylcholine / Onset and depth of muscle relaxation Theophylline / Effect of atracurium Trimethaphan / Muscle relaxation Verapamil / Muscle relaxation

How Supplied: Injection: 10 mg/mL

Dosage
?IV Bolus Only Intubation and maintenance of neuromuscular blockade.
Adults and children over 2 years, initial: 0.4-0.5 mg/kg as IV bolus; maintenance: 0.08-0.1 mg/kg. The first maintenance dose is usually required 20-45 min after the initial dose. Give maintenance doses every 15-25 min under balanced anesthesia, slightly longer under isoflurane or enflurane anesthesia.
Following use of succinylcholine for intubation under balanced anesthesia.
Initial: 0.3-0.4 mg/kg; if using potent inhalation anesthetics, further reductions may be required.
Use in neuromuscular disease, severe electrolyte disorders, or carcinomatosis.
Consider dosage reductions where potentiation of neuromuscular blockade or difficulty with reversal have been noted.
Use after steady-state enflurane or isoflurane anesthesia established.
0.25-0.35 mg/kg (about 1/3 less than the usual initial dose).
Use in infants 1 month to 2 years of age under halothane anesthesia.
0.3-0.4 mg/kg. More frequent maintenance doses may be required.
?IV Infusion Balanced anesthesia.
IV infusion: 9-10 mcg/kg until the level of neuromuscular blockade is reestablished; then, rate of infusion is adjusted according to client needs (usually 5-9 mcg/kg/min although some clients may require as little as 2 mcg/kg/min and others as much as 15 mcg/kg/min).
For cardiopulmonary bypass surgery in which hypothermia is induced.
Reduce rate of infusion by 50%.