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Atracurium Besilate information from DrugsUpdate  

See Available Brands of Atracurium Besilate in India

P - Caution when used during pregnancy
L - Caution when used during lactation

A nondepolarizing neuromuscular relaxant of intermediate duration of action; used as an adjunct to general anesthesia; a curarelike agent.

Pharmacodynamics

Pharmacokinetics

Atracurium besilate blocks neural transmission at the neuromuscular junction by competitive binding at the cholinergic receptor sites on the motor end plate.

Distribution
Protein binding: 80%.

Excretion
Excretion in urine and bile, mostly as metabolites. Elimination half-life: about 20 min.

Atracurium Besilate Indications / Atracurium Besilate Uses

Information Not Available

Atracurium Besilate Adverse Reactions / Atracurium Besilate Side Effects

Cutaneous reactions; bradycardia, transient hypotension in patients with CVS disorders; dyspnoea, bronchospasm; rash and urticaria.

Precautions

Information Not Available

Special Precautions

Neonates; severe CVS disorders; renal or hepatic dysfunction; myasthenia gravis and other neuromuscular disorders; severe electrolyte imbalances; respiratory insufficiency or pulmonary disease, asthma; burns; cardiopulmonary bypass; smoking; pregnancy and lactation. Dosage for obese patients should be based on ideal body-weight to prevent overdosing.

Other Drug Interactions

Mixed block with suxamethonium which is difficult to reverse with anticholinergic drugs. Ketamine may potentiate the effects of atracurium. Concurrent use with tamoxifen or danazol may prolong effects of atracurium.


Potentially Fatal: Neuromuscular blockade potentiated by parenteral Mg salts, anaesthetics, aminoglycosides and polypeptide antibiotics, botulinum A toxin. Malignant hyperthermia with halogenated anaesthetics and succinylcholine. MAOIs.

Other Interactions

Information Not Available

Dosage

Intravenous
Aid controlled ventilation, Muscle relaxant in general anaesthesia, Endotracheal intubation

Adult: Initially, 300-600 mcg/kg as inj. Subsequently, 100-200 mcg/kg when necessary or every 15-25 minutes for maintenance in prolonged procedures. Alternatively, maintenance can also be achieved by continuous infusion at 5-10 mcg/kg/minute. Initial dose should be given over 60 seconds in patients with CV disease. Dose should be calculated based on ideal body-weight in obese patients.

Child: ≥2 mth: Initially, 400-500 mcg/kg as inj. Maintenance dose: 80-100 mcg/kg; first maintenance dose may be given 20-45 min after the initial dose, subsequently, may be repeated every 15-25 min. For children 1 mth-2 yr: 300-400 mcg/kg may be used as initial dose in those who are under halothane anaesthesia. Maintenance doses may be admin more frequently in infant and children than adults.

Special Populations


For patients with significant CV disease or any history (e.g. severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release, an initial dose of 0.3-0.4 mg/kg should be given slowly or in divided doses over 1 min. For adults receiving atracurium following the use of succinylcholine for intubation under balanced anesthesia, an initial dose of 0.3-0.4 mg/kg is recommended. Dosage reductions may be necessary in patients with neuromuscular disease, severe electrolyte disorders or carcinomatosis in which potentiation of neuromuscular block or difficulties with reversal have been demonstrated.

Reconstitution


May be diluted in normal saline, dextrose 5% in water or dextrose 5% in normal saline.


Incompatibility


Incompatible with alkaline solutions and lactated Ringer's solution. Y-site incompatibility: Diazepam, thiopental, propofol. Admixture incompatibility: Ranitidine, sodium nitroprusside, heparin, cefazolin, aminophylline, quinidine gluconate.

Food(before/after)

Information Not Available

List of Contraindications

Atracurium Besilate and Pregnancy

Caution when used during pregnancy


Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Atracurium Besilate and Lactation

Caution when used during lactation

Atracurium Besilate and Children

Information Not Available

Atracurium Besilate and Geriatic

Information Not Available

Atracurium Besilate and Other Contraindications

Hypersensitivity

Storage

Intravenous
Intact vials: Refrigerate at 2-8°C. Do not freeze. Dilutions of 0.2 mg/ml or 0.5 mg/ml are stable for up to 24 hour at room temperature or under refrigeration.

Lab interference

Intravenous
Intact vials: Refrigerate at 2-8°C. Do not freeze. Dilutions of 0.2 mg/ml or 0.5 mg/ml are stable for up to 24 hour at room temperature or under refrigeration.

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