ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Tracrium, Tracurium
ICU INDICATIONS:
- Muscle Relaxant
PRESENTATION AND ADMINISTRATION:
IV:
50 mg in 5 mL solution
Administer neat for IV injection or infusion
Compatible with the following IV fluids:
Normal saline, 5% dextrose, dextrose and sodium chloride, Hartmanns
Note: only compatible in Hartmann's for 4 hours therefore do not use by infusion
Tracrium is a sterile, non-pyrogenic aqueous solution. Each mL contains 10 mg atracurium besylate. Atracurium besylate slowly loses potency with time at the rate of approximately 6% per year under refrigeration. Atracurium besylate should be refrigerated at 2-8°C to preserve potency. Rate of loss in potency increases to approximately 5% per month at 25°C. Upon removal from refrigeration to room temperature storage conditions, use atracurium besylate within 14 days even if re-refrigerated
DOSAGE:
IV:
0.3-0.6 mg/kg stat (usually give 50 mg) then 0.1-0.2 mg/kg when required or 5-9 mcg/kg/min
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
IV:
0.3-0.6 mg/kg stat then 0.1-0.2 mg/kg when required or 5-10 mcg/kg/min
CLINICAL PHARMACOLOGY:
Atracurium besylate is an intermediate-duration, nondepolarising, skeletal muscle relaxant. Elimination of atracurium is not dependent on renal clearance mechanisms and no dose adjustment is required in renal impairment
CONTRAINDICATIONS:
- Hypersensitivity to atracurium
WARNINGS:
Although atracurium besylate 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 besylate to patients in whom substantial histamine release would be especially hazardous (such as patients with clinically significant cardiovascular disease) and in patients with any history (such as severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release
PRECAUTIONS:
General:
Atracurium besylate may have profound effects on patients with myasthenia gravis, Eaton-Lambert syndrome, or other neuromuscular diseases in which potentiation of nondepolarising agents has been noted. The use of a peripheral nerve stimulator is especially important for assessing neuromuscular block in these patients.
When there is a need for long-term mechanical ventilation, the benefits-to-risk ratio of neuromuscular block must be considered. Little information is available on the plasma levels and clinical consequences of atracurium metabolites that may accumulate during days to weeks of atracurium administration in ICU patients. Laudanosine, a major biologically active metabolite of atracurium without neuromuscular blocking activity, produces transient hypotension and, in higher doses, cerebral excitatory effects (generalised muscle twitching and seizures) when administered to several species of animals. There have been rare spontaneous reports of seizures in ICU patients who have received atracurium or other agents
Laboratory Tests:
No tests additional to routine ICU tests are required
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Drugs which may enhance the neuromuscular blocking action of atracurium besylate include certain antibiotics (especially aminoglycosides and polymyxinslithium), magnesium salts, procainamide, quinidine.
The prior administration of succinylcholine does not enhance the duration but quickens the onset and may increase the depth of neuromuscular block induced by atracurium besylate.
ADVERSE REACTIONS:
General:
Allergic reactions (anaphylactic or anaphylactoid responses) which in rare instances may be severe and result in cardiac arrest
Musculoskeletal:
Inadequate block, prolonged block
Cardiovascular:
Hypotension, vasodilatation (flushing), tachycardia, bradycardia
Respiratory:
dyspnoea, bronchospasm, laryngospasm
Integumentary:
Rash, urticaria, reaction at injection site