atracurium (Rx)

Brand and Other Names:Tracrium
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
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Endotracheal Intubation, Mechanical Ventilation

Calculate dose based on ideal body weight

0.4-0.5 mg/kg IVP over 60 seconds, then 0.08-0.1 mg/kg 20-45 minutes after initial dose to maintain neuromuscular block, repeat maintenance dose q15-25min PRN OR 

Continuous infusion: 0.005-0.01 mg/kg/min IV (ranges from 0.002-0.015 mg/kg/min) OR

0.2-0.4 mg/kg IVP if following succinylcholine for intubation

Skeletal Muscle Relaxation During Surgery

0.4-0.5 mg/kg IVP over 60 seconds, then 005-010 mg/kg/min; block usually maintained at rate of 0.011-0.013 mg/kg/min

Renal Impairment

Dose adjustment not necessary

Hepatic Impairment

Dose adjustment not necessary

Administration

Reduce dose if given with general anesthetics that potentiate its activity (eg, isoflurane)

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
more...

Endotracheal Intubation, Mechanical Ventilation

<1 month old: Safety and efficacy not established

1 month - 2 years: 0.3-0.4 mg/kg IVP under halothane anesthesia 

Maintenance dose: Children may need more frequent maintenance doses than adult

>2 years: 0.4-0.5 mg/kg IVP over 60 seconds, then 0.08-0.1 mg/kg 20-45 minutes after initial dose to maintain neuromuscular block, repeat maintenance dose q15-25min PRN

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Interactions

Interaction Checker

and atracurium

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Skin flush (5%)

            <1%

            Erythema (0.6%)

            Wheezing (0.2%)

            Increased bronchial secretions (0.2%)

            Pruritus (0.2%)

            Urticaria (0.1%)

            Postmarketing Reports

            Wheals

            Erythema at injection site

            Bronchospasm (0.01%)

            Cyanosis (0.001%)

            Changes in heart rate (0.6-2.1%)

            Mean arterial pressure (1.9%)

            Diastolic arterial pressure changes

            Systemic vascular resistance changes

            Cardiac index changes

            Cardiac output changes

            Cardiac arrest (0.001%)

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            Warnings

            Contraindications

            Hypersensitivity to drug or components; lack of ventilatory support, neuromuscular disease

            Cautions

            Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent

            Closely monitor patients with bronchogenic carcinoma, dehydration, electrolyte imbalance, hypotension, hypothermia, myasthenia gravis, pulmonary disease

            Adequate ventilatory support mandatory, may experience resistance with >25% TBSA burns, may experience increased sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excretion in milk unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist

            Pharmacokinetics

            Onset: 2-3 min; may be slightly delayed in patients with renal failure

            Duration: 20-35 min

            Half-Life: 2-3.4 min (distribution); 20 min (terminal)

            Protein bound: 82%

            Vd: 160 mL/kg (range: 120-188 mL/kg)

            Metabolism: Metabolized to laudanoside by non-enzymatic cleavage independent of hepatic/renal function

            Excretion: Urine (5%) & also in feces via biliary elimination

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            Administration

            IV Compatibilities

            Solution: D5/NS, D5W(?), NS(?)

            Additive: bretylium, cimetidine, ciprofloxacin, dobutamine, dopamine, esmolol, gentamicin, isoproterenol, lidocaine, morphine, KCl, procainamide, vancomycin

            Syringe: alfentanil, fentanyl, midazolam, sufentanil

            Y-site: amiodarone, cefazolin, cefuroxime, cimetidine, clarithromycin, dobutamine, dopamine, epinephrine, esmolol, etomidate, fenoldopam, fentanyl, gentamicin, heparin, Hextend, hydrocortisone, isoproterenol, lorazepam, midazolam, milrinone, morphine, nitroglycerin, ranitidine, Na nitroprusside, trimethoprim/sulfamethoxazole, vancomycin

            IV Incompatibilities

            Solution: LR

            Additive: aminophylline, cefazolin, heparin, quinidine gluconate, ranitidine, sodium nitroprusside

            Syringe: alkaline solutions

            Y-site: diazepam, propofol(?), thiopental

            IV Preparation

            Add to an empty Viaflex bag & infuse undiluted (10 mg/mL); however, if necessary, may be diluted in D5W, NS or dextrose-saline combinations

            Dilution in LR not recommended

            IV Administration

            Not for IM injection due to tissue irritation

            May be given undiluted as bolus injection

            Administration via infusion requires use of an infusion pump

            Use infusion solutions within 24 hr of preparation

            Storage

            Refrigerate

            Unstable in alkaline solutions

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            Adding plans allows you to:

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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.