Atracurium besilate

Generic Medicine Info
Indications and Dosage
Endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 300-600 mcg/kg as bolus inj, w/ subsequent doses of 100-200 mcg/kg by inj every 15-25 min or 5-10 mcg/kg/min by infusion in prolonged procedures. Higher infusion rate may be used in patients undergoing controlled ventilation in intensive care.
Child: >1 mth Same as adult dose.
Special Patient Group
Patients w/ CV disease: Initial dose should be administered over a period of at least 60 sec.
Alkaline soln (e.g. barbiturate soln).
Special Precautions
Patient w/ CV disease, burn injury, asthma; conditions which may antagonise neuromuscular blockade (e.g. resp alkalosis, hypercalcaemia, demyelinating lesions, peripheral neuropathies, denervation, muscle trauma); conditions which may potentiate neuromuscular blockade (e.g. electrolyte abnormalities, neuromuscular diseases, metabolic acidosis, resp acidosis, Eaton-Lambert syndrome, myasthenia gravis). Pregnancy and lactation.
Adverse Reactions
Skin flush, erythema, pruritus, urticaria, wheezing, increased bronchial secretions, bronchospasm, cyanosis, angioedema, CV effects (e.g. bradycardia); wheals and erythema at inj site.
Potentially Fatal: Anaphylaxis.
IV/Parenteral: C
Patient Counseling Information
May impair ability to drive or operate machinery.
Monitoring Parameters
Monitor heart rate, BP, resp rate; degree of muscle relaxation; renal and hepatic function when in the intensive care unit.
Symptoms: Stimulation of histamine release, CV effects esp hypotension. Management: Supportive and symptomatic treatment. Maintain adequate, patent airway w/ manual or mechanical ventilation, as necessary. May administer neostigmine, edrophonium or pyridostigmine to reverse neuromuscular blockade. If CV support is needed, treatment should include proper positioning, fluid admin and use of vasopressors as necessary.
Drug Interactions
Enhanced neuromuscular blocking effect w/ general anaesth (e.g. enflurane, isoflurane, halothane), certain antibiotics (e.g. aminoglycosides, polymyxins), lithium, Mg salts, procainamide, quinidine.
Mechanism of Action: Atracurium produces neuromuscular blockade by competing w/ acetylcholine for receptors on the motor end-plate of the myoneural junction.
Onset: 2-3 min.
Duration: 15-35 min.
Distribution: Crosses the placenta (small amounts). Volume of distribution: 120-188 mL/kg. Plasma protein binding: Approx 80%.
Metabolism: Converted to laudanosine and other metabolites by degradation via Hofmann elimination; undergoes ester hydrolysis by non-specific plasma esterases.
Excretion: Via urine and bile, mostly as metabolites. Elimination half-life: Approx 20 min.
Chemical Structure

Chemical Structure Image
Atracurium besilate

Source: National Center for Biotechnology Information. PubChem Database. Atracurium besylate, CID=47320, (accessed on Jan. 21, 2020)

Store between 2-8°C. Do not freeze.
MIMS Class
Neuromuscular Blocking Agents
ATC Classification
M03AC04 - atracurium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
Anon. Atracurium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. Accessed 03/08/2015.

Atracurium Besylate Injection, Solution (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. Accessed 03/08/2015.

Buckingham R (ed). Atracurium Besilate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. Accessed 03/08/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Atracurium Besylate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). Accessed 03/08/2015.

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