Use by injection in Adults:
Atracurium is administered by IV injection.
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 min.
Endotracheal intubation can usually be accomplished within 90 seconds from Intravenous 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 35 min as measured by the restoration of the tetanic response of 95% of normal neuromuscular function. The neuromuscular block produced by Atracurium can be rapidly reversed by standard doses of anticholinesterase agents, e.g. neostigmine 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, Atracurium can be used to maintain neuromuscular block during long surgical procedures by administration as continuous infusion at rates 0.3-0.6 mg/kg/hr. Atracurium can be administered by infusion during cardiopulmonary bypass surgery at the recommended infusion rates. Induced hypothermia to a body temperature of 25-26°C by maintained approximately half the original infusion rate at these low temperatures. Atracurium is compatible with the following infusion solutions for the times stated in the table. (See table.)
Click on icon to see table/diagram/image
When diluted in these solutions to give Atracurium besylate concentration of not more than 0.5 mg/mL, the resultant solutions will be stable in daylight for the stated periods at the temperatures of up to 30°C.
The dosage in children more than 1 month is the same as that in adult on a body weight basis.
Atracurium may be used a 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:
Atracurium 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 Atracurium should be administered over a period of 60 sec.
Intensive Care Unit (ICU) patients:
After an optional initial bolus dose of 0.3-0.6 mg/kg, Atracurium can be used to maintain neruomuscular block by administering a continuous infusion at rates of between 11 and 13 μg/kg/min (0.65-0.78 mg/kg/hr). However, there is wide inter-patient variability in dosage requirements. Dosage requirements may change with time. Infusion rates as low as 4.5 μg/kg/min (0.27 mg/kg/hr) or as high as 29.5 μg/kg/min (1.77 mg/kg/hr) are required in some patients. The rate of spontaneous recovery from neuromuscular block after infusion of Atracurium in ICU patients is independent of the duration of administration. Spontaneous recovery to a train-of-four ration >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 min. A range of 32-108 min has been observed in clinical trials.
In common with all the neuromuscular-blocking agents, monitoring of neuromuscular function is recommended during the use of Atracurium in order to individual dosage requirements.