Generic Name and Formulations:
Atracurium besylate 10mg/mL; soln for IV inj.
Various generic manufacturers
Adjunct to general anesthesia to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
<1month: not recommended. Individualize. 1month to 2yrs (under halothane anesthesia): initially 0.3–0.4mg/kg. ≥2yrs: initially 0.4–0.5mg/kg IV bolus. Inhalation anesthetics (eg, enflurane, isoflurane): 0.25–0.35mg/kg. Prolonged surgery: maintenance dose of 0.08–0.10mg/kg, usually given 20–45 minutes after initial inj dose. Intubation with succinylcholine, significant cardiovascular disease, history of severe anaphylaxis or asthma: initially 0.3–0.4mg/kg given slowly or in divided doses over 1 minute. Neuromuscular disease, severe electrolyte disorders, or carcinomatosis: consider dose reductions. Use by continuous infusion: see literature. Monitor with a peripheral nerve stimulator to avoid overdosage.
Hypersensitivity to benzyl alcohol (multidose vials).
To be administered under the supervision of experienced clinicians. Have intubation, artificial respiration, oxygen therapy and reversal agents available. Not for IM administration. Increased risk of substantial histamine release (eg, cardiovascular disease, severe anaphylaxis or asthma history). Myasthenia gravis or myasthenic (Eaton-Lambert) syndrome. Severe electrolyte disorders or carcinomatosis. Malignant hyperthermia. Resistance may develop in burn patients. Bronchial asthma. Long-term use in I.C.U. Neonates. Elderly. Labor & delivery. Pregnancy (Cat.C). Nursing mothers.
Prior administration of succinylcholine may potentiate effects (give atracurium only after succinylcholine recovery). Potentiated by volatile inhalational anesthetics (eg, enflurane, isoflurane, halothane), aminoglycosides, polymyxins, lithium, magnesium salts, procainamide, quinidine. Concomitant other muscle relaxants may have synergistic or antagonistic effects.
Neuromuscular blocker (nondepolarizing).
Skin flushing, erythema, tachycardia, inadequate or prolonged musculoskeletal block, hypotension, bradycardia, dyspnea; rare: seizures, severe hypersensitivity reactions.
Formerly known under the brand name Tracrium.
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