Use by Injection in Adults:
Notrixum is administered by IV Injection/IV Infusion.
Dosage Range for Adults:
0.3–0.6 mg/kg (depending on the duration of full block required) and will provide relaxation for about 15–35 minutes. Endotracheal intubation can usually be accomplished within 90 seconds from I.V injection of 0.5–0.6 mg/kg.
Full block can be prolonged with supplementary doses of 0.1–0.2 mg/kg as required. Successive supplementary dosing does not give rise to accumulation of neuromuscular-blocking effect. Spontaneous recovery from the end of full block occurs in about 35 minutes as measured by the restoration of the tetanic response to 95% of normal neuromuscular function. The neuromuscular block produced by Notrixum can be rapidly reversed by standard doses of anticholinesterase agents, e.g neogtismine and edrophonium, accompanied or preceded by atropine, with no evidence of re-curarisation.
Use as an Infusion in Adults:
After an initial bolus dose of 0.3–0.6 mg/kg, Notrixum can be used to maintain neuromuscular block during long surgical procedures by administration as a continuous infusion at rates of 0.3–0.6 mg/kg/hr.
Notrixum can be administered by infusion during cardiopulmonary bypass surgery at the recommended infusion rates. Induced hypothermia to a body temperature of 25–26°C reduces the rate of inactivation of Atracurium besylate, therefore, full neuromuscular block may be maintained by approximately half the original infusion rate at these low temperatures.
Notrixum is compatible with the following infusion solutions for the times stated as follows: (See table.)
Click on icon to see table/diagram/image
When diluted in these solutions, the resultant solutions will be stable in daylight for the stated periods at room temperatures.
The dosage in children >1 month is the same as that in adult on a body weight basis.
Notrixum may be used at standard dosage in elderly patients. It is recommended, however, that the initial dose be at the lower end of the range and that it be administered slowly.
Patients with Reduced Renal and/or Hepatic Function:
Notrixum may be used at standard dosage at all levels of renal or hepatic function, including end-stage failure.
Patients with Cardiovascular Disease:
In patients with clinically significant cardiovascular disease, the initial dose of Notrixum should be administered over a period of 60 seconds.
Intensive Care Unit (ICU) Patients:
After an optional initial bolus dose of 0.3–0.6 mg/kg, Notrixum can be used to maintain neuromuscular block by administering a continuous infusion at rates of between 11 and 13 μg/kg/minute (0.65–0.78 mg/kg/hour). However, there is wide interpatient variability in dosage requirements.
Dosage requirements may change with the time. Infusion rates as low as 4.5 μg/kg/minute (0.27 mg/kg/hour) or as high as 29.5 μ g/kg/minute (1.77 mg/kg/hour) are required in some patients. The rate of spontaneous recovery from neuromuscular block after infusion of Notrixum in ICU Patients is independent of the duration of administration. Spontaneous recovery to a train-of-four-ratio >0.75 (the ratio of the height of the 4th to the 1st twitch in a train-of-four) can be expected to occur in approximately 60 minutes. A range of 32–108 minutes has been observed in clinical trials.
Monitoring: In common with all neuromuscular-blocking agents, monitoring of neuromuscular function is recommended during the use of Notrixum in order to individual dosage requirements.
Mode of Administration: