Drug information of Atracurium

Atracurium

Drug group:

Atracurium besylate is an intermediate-duration, nondepolarizing, skeletal muscle relaxant for intravenous administration Atracurium Besylate Injection is indicated, as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Mechanism of effect

Atracurium besylate is a nondepolarizing skeletal muscle relaxant. Nondepolarizing agents antagonize the neurotransmitter action of acetylcholine by binding competitively with cholinergic receptor sites on the motor end-plate.

Pharmacodynamic

Atracurium is a nondepolarizing skeletal muscle relaxant. the time to onset decreases and the duration of maximum effect increases with increasing doses of Atracurium

Pharmacokinetics

Poorly absorbed from the GI tract. Time to maximum neuromuscular blockade decreases as the dose increases Following IV administration of 0.4–0.5 mg/kg, maximum neuromuscular blockade generally occurs within 3-–5 minutes ، Distributed into extracellular fluid، Plasma Protein Binding، 82%، Excreted principally in urine and also in feces via biliary elimination، half-life is approximately 20 minutes،

Drug indications

Skeletal Muscle Relaxation

Dosage

Infants and children
1 month to 2 years of age: 0.3–0.4 mg/kg when used concomitantly with halothane anesthesia
Children >2 years of age should receive dosages recommended for adults
-- Adults: 0.4–0.5 mg/kg Reduce initial dosage by about 33% (i.e., to 0.25–
0.35 mg/kg) if steady-state anesthesia has been induced with enflurane or isoflurane 0.08–0.1 mg/kg, administered as necessary Administer first maintenance dose generally 20–45 minutes after the initial dose in patients undergoing balanced anesthesia Administer repeat maintenance doses at relatively regular intervals (i.e., from 15–25 minutes in patients undergoing balanced anesthesia Initially, 9–10 mcg/kg per minute may be necessary to rapidly counteract spontaneous recovery from neuromuscular blockade 5–9 mcg/kg per minute generally maintains 89–99% neuromuscular blockade in patients receiving balanced anesthesia; however, adequate blockade may occur with infusion rates of 2–15 mcg/kg per minute

Alerts

1-ATRACURIUM SHOULD BE USED ONLY BY THOSE SKILLED IN AIRWAY MANAGEMENT AND RESPIRATORY SUPPORT. EQUIPMENT AND PERSONNEL MUST BE IMMEDIATELY AVAILABLE FOR ENDOTRACHEAL INTUBATION AND SUPPORT OF VENTILATION, INCLUDING ADMINISTRATION OF POSITIVE PRESSURE OXYGEN.
ADEQUACY OF RESPIRATION MUST BE ASSURED THROUGH ASSISTED OR CONTROLLED VENTILATION. ANTICHOLINESTERASE REVERSAL AGENTS SHOULD BE IMMEDIATELY AVAILABLE.
2-DO NOT GIVE ATRACURIUM BESYLATE BY INTRAMUSCULAR ADMINISTRATION.
3-Atracurium has no known effect on consciousness, pain threshold, or cerebration. It should be used only with adequate anesthesia.
4-Atracurium Besylate Injection, which has an acid pH, should not be mixed with alkaline solutions (e.g., barbiturate solutions) in the same syringe or administered simultaneously during intravenous infusion through the same needle. Depending on the resultant pH of such mixtures, atracurium may be inactivated and a free acid may be precipitated.
5-Atracurium Besylate Injection 10 mL multiple dose vials contain benzyl alcohol. In neonates, benzyl alcohol has been associated with an increased incidence of neurological and other complications which are sometimes fatal. Atracurium besylate 5 mL single use vials do not contain benzyl alcohol
6-Although atracurium is a less potent histamine releaser than d-tubocurarine or metocurine, the possibility of substantial histamine release in sensitive individuals must be considered.
Special caution should be exercised in administering atracurium to patients in whom substantial histamine release would be especially hazardous (e.g., patients with clinically significant cardiovascular disease) and in patients with any history (e.g., severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release

Points of recommendation

1-Since atracurium has no clinically significant effects on heart rate in the recommended dosage range, it will not counteract the bradycardia produced by many anesthetic agents or vagal stimulation.
As a result, bradycardia during anesthesia may be more common with atracurium than with other muscle relaxants
2-Atracurium may have profound effects in patients with myasthenia gravis, Eaton-Lambert syndrome, or other neuromuscular diseases in which potentiation of nondepolarizing agents has been noted. The use of a peripheral nerve stimulator is especially important for assessing neuromuscular block in these patients. Similar precautions should be taken in patients with severe electrolyte disorders or carcinomatosis.
3-Multiple factors in anesthesia practice are suspected of triggering malignant hyperthermia (MH), a potentially fatal hypermetabolic state of skeletal muscle
4-The safety of atracurium has not been established in patients with bronchial asthma

Pregnancy level

C


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