Atracurium

• It is used to calm muscles during surgery.
• It is used to calm muscles while on a breathing machine.

Use atracurium as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• It is given as a shot into a vein.
• It is given as an infusion into a vein over a period of time.

What do I do if I miss a dose?

• This medicine is given on an as needed basis.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

• Neuromuscular Blocker Agent, Nondepolarizing

Blocks neural transmission at the myoneural junction by binding with cholinergic receptor sites

Distribution

Vd:

Infants: 0.21 L/kg

Children: 0.13 L/kg

Adults: 0.1 L/kg

Metabolism

Undergoes ester hydrolysis and Hofmann elimination (nonbiologic process independent of renal, hepatic, or enzymatic function); metabolites have no neuromuscular blocking properties; laudanosine, a product of Hofmann elimination, is a CNS stimulant and can accumulate with prolonged use. Laudanosine is hepatically metabolized.

Excretion

Urine (<5%)

Clearance:

Infants: 7.9 mL/kg/minute

Children: 6.8 mL/kg/minute

Adults: 5.3 mL/kg/minute

Dose dependent: 2 to 3 minutes; Peak effect: 3 to 5 minutes

Adjunct to surgical anesthesia (neuromuscular blockade): As an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Note: Atracurium does not relieve pain or produce sedation.

Adjunct to surgical anesthesia (neuromuscular blockade): IV (not to be used IM): Dose to effect; doses must be individualized due to interpatient variability; use ideal body weight for obese patients

Infants and Children <2 years: Initial: 0.3 to 0.4 mg/kg followed by maintenance doses as needed to maintain neuromuscular blockade. Note: Maintenance doses in infants and children may need to be administered with slightly greater frequency compared to adults.

Children ≥2 years and Adolescents: 0.4 to 0.5 mg/kg, then 0.08 to 0.1 mg/kg administered 20 to 45 minutes after initial dose to maintain neuromuscular block; repeat dose at 15- to 25-minute intervals as needed. Note: Initial dose may be reduced to 0.3 to 0.4 mg/kg in patients with significant cardiovascular disease or history of elevated risk of histamine release (eg, severe anaphylactoid reactions or asthma).

Maintenance infusion for continued surgical relaxation during extended surgical procedures: Children ≥2 years and Adolescents: At initial signs of recovery from bolus dose, a continuous infusion may be initiated at a rate of 9 to 10 mcg/kg/minute (0.54 to 0.6 mg/kg/hour); block usually maintained by a rate of 5 to 9 mcg/kg/minute (0.3 to 0.54 mg/kg/hour) under balanced anesthesia; range: 2 to 15 mcg/kg/minute (0.12 to 0.9 mg/kg/hour)

No dosage adjustment necessary.

Adverse events were observed in animal reproduction studies. Small amounts of atracurium have been shown to cross the placenta when given to women during cesarean section.