| ATRACURIUM BESYLATE
Classifications: skeletal muscle relaxant, nondepolarizing; neuromuscular blocker; Therapeutic: skeletal muscle relaxant; neuromuscular blocker
Pregnancy Category: C
10 mg/mL injection
Inhibits neuromuscular transmission by binding competitively with acetylcholine to muscle end plate receptors. Has no apparent
effect on pain threshold, consciousness, or cerebration. Given in general anesthesia only after unconsciousness has been
induced by other drugs.
Synthetic skeletal muscle relaxant that produces short duration of neuromuscular blockade, exhibits minimal direct effects
on cardiovascular system, and has less histamine-releasing action.
Adjunct for general anesthesia to produce skeletal muscle relaxation during surgery; to facilitate endotracheal intubation.
Especially useful for patients with severe renal or hepatic disease, limited cardiac reserve, and in patients with low or
atypical pseudocholinesterase levels.
Myasthenia gravis; pregnancy (category C). Safety during lactation is not established.
When appreciable histamine release would be hazardous (as in asthma or anaphylactoid reactions, significant cardiovascular
disease), neuromuscular disease (e.g., Eaton-Lambert syndrome), carcinomatosis, electrolyte or acidbase imbalances,
dehydration, impaired pulmonary function.
Route & Dosage
|Skeletal Muscle Relaxation
Adult/Child (≥2 y): IV 0.40.5 mg/kg initial dose, then 0.080.1 mg/kg bolus 2045 min after the first dose and q1525 min
thereafter; reduce doses if used with general anesthetics
Child (1 mo2 y): IV 0.30.4 mg/kg
Adult: IV 59 mcg/kg/min by continuous infusion
- Verify correct concentration and rate of infusion for infants and children with physician.
PREPARE: Direct: Give initial bolus dose undiluted. Continuous: Maintenance dose must be diluted with NS, D5W or D5/NS. Maximum concentration should be 0.5 mg/mL. Do not mix in same syringe
or administer through same needle as used for alkaline solutions [incompatible with alkaline solutions (e.g., barbiturates)].
ADMINISTER: Direct: Give as bolus dose over 3060 sec. Continuous: Give infusion at rate required to maintain desired effect.
INCOMPATIBILITIES Solution/additive: Ringer's lactate, aminophylline, cefazolin, heparin, quinidine, ranitidine, sodium nitroprusside. Y-site: Diazepam, propofol, thiopental.
- Store at 2°8° C (36°46° F) to preserve potency unless otherwise directed. Avoid freezing.
Adverse Effects (≥1%)CV:
Bradycardia, tachycardia. Respiratory: Respiratory depression. Other:
Increased salivation, anaphylaxis.
InteractionsDrug: general anesthetics
increase magnitude and duration of neuromuscular blocking action; aminoglycosides
, bacitracin, polymyxin B, clindamycin, lidocaine, parenteral magnesium, quinidine, quinine, trimethaphan, verapamil
increase neuromuscular blockade; diuretics
may increase or decrease neuromuscular blockade; lithium
prolongs duration of neuromuscular blockade; narcotic analgesics
present possibility of additive respiratory depression; succinylcholine
increases onset and depth of neuromuscular blockade; phenytoin
may cause resistance to or reversal of neuromuscular blockade.
2 min. Peak:
35 min. Duration:
6070 min. Distribution:
Well distributed to tissues and extracellular fluids; crosses placenta; distribution into breast milk unknown. Metabolism:
Rapid nonenzymatic degradation in bloodstream. Elimination:
7090% in urine in 57 h. Half-Life:
Assessment & Drug Effects
- Lab tests: Baseline serum electrolytes, acidbase balance, and renal function as part of preanesthetic assessment.
- Note: Personnel and equipment required for endotracheal intubation, administration of oxygen under positive pressure, artificial
respiration, and assisted or controlled ventilation must be immediately available.
- Evaluate degree of neuromuscular blockade and muscle paralysis to avoid risk of overdosage by qualified individual using
peripheral nerve stimulator.
- Monitor BP, pulse, and respirations and evaluate patient's recovery from neuromuscular blocking (curare-like) effect as evidenced
by ability to breathe naturally or to take deep breaths and cough, keep eyes open, lift head keeping mouth closed, adequacy
of hand-grip strength. Notify physician if recovery is delayed.
- Note: Recovery from neuromuscular blockade usually begins 3545 min after drug administration and is almost complete in about
1 h. Recovery time may be delayed in patients with cardiovascular disease, edematous states, and in older adults.