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      Drugs & Diseases

      atracurium (Rx)

      Brand and Other Names:Tracrium
      • Print

      Dosing & Uses

      AdultPediatric

      Dosage Forms & Strengths

      injectable solution

      • 10mg/mL

      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

      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

      Next:

      Interactions

      Interaction Checker

      and atracurium

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                Contraindicated (0)

                  Serious - Use Alternative (29)

                  • amikacin

                    amikacin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

                  • amphotericin B deoxycholate

                    amphotericin B deoxycholate increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • benzhydrocodone/acetaminophen

                    benzhydrocodone/acetaminophen, atracurium. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                  • capreomycin

                    capreomycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • clindamycin

                    clindamycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • colistin

                    atracurium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.

                  • demeclocycline

                    demeclocycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • doxycycline

                    doxycycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • fentanyl

                    fentanyl, atracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

                  • fentanyl intranasal

                    fentanyl intranasal, atracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

                  • fentanyl transdermal

                    fentanyl transdermal, atracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

                  • fentanyl transmucosal

                    fentanyl transmucosal, atracurium. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

                  • gentamicin

                    gentamicin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

                  • hydrocodone

                    hydrocodone, atracurium. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                  • lincomycin

                    lincomycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • minocycline

                    minocycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • neomycin PO

                    neomycin PO increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

                  • omadacycline

                    omadacycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • oxytetracycline

                    oxytetracycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • paromomycin

                    paromomycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

                  • polymyxin B

                    polymyxin B increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.

                  • pramlintide

                    pramlintide, atracurium. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

                  • quinine

                    quinine increases effects of atracurium by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.

                  • sarecycline

                    sarecycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • streptomycin

                    streptomycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

                  • sufentanil SL

                    sufentanil SL, atracurium. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                  • tetracycline

                    tetracycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

                  • tobramycin

                    tobramycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

                  • valerian

                    valerian and atracurium both increase sedation. Avoid or Use Alternate Drug.

                  Monitor Closely (109)

                  • abobotulinumtoxinA

                    atracurium increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Neuromuscular blockers may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

                  • aclidinium

                    atracurium and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • amitriptyline

                    atracurium and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • amoxapine

                    atracurium and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • anticholinergic/sedative combos

                    anticholinergic/sedative combos and atracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • aripiprazole

                    atracurium decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

                    aripiprazole increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • atropine

                    atracurium and atropine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • atropine IV/IM

                    atracurium and atropine IV/IM both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • belladonna alkaloids

                    atracurium and belladonna alkaloids both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • belladonna and opium

                    atracurium and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • benperidol

                    atracurium decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                    benperidol increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • betamethasone

                    atracurium, betamethasone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • bethanechol

                    bethanechol increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • buprenorphine, long-acting injection

                    atracurium increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

                  • carbachol

                    carbachol increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • cevimeline

                    cevimeline increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • chlorpromazine

                    atracurium decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    chlorpromazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • cisatracurium

                    atracurium and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • clomipramine

                    atracurium and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • clozapine

                    atracurium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

                    clozapine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • corticotropin

                    atracurium, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • cortisone

                    atracurium, cortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • cyclizine

                    atracurium and cyclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • cyclobenzaprine

                    atracurium and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • darifenacin

                    atracurium and darifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • deflazacort

                    atracurium, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • dexamethasone

                    atracurium, dexamethasone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • dicyclomine

                    atracurium and dicyclomine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • diphenhydramine

                    atracurium and diphenhydramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • donepezil

                    donepezil increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • donepezil transdermal

                    donepezil transdermal and atracurium both increase pharmacodynamic synergism. Use Caution/Monitor. Donepezil transdermal, a cholinesterase inhibitor, may potentiate the effects on muscle relacation during anesthesia.

                  • dosulepin

                    atracurium and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • doxapram

                    doxapram decreases effects of atracurium by pharmacodynamic antagonism. Use Caution/Monitor.

                  • doxepin

                    atracurium and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • droperidol

                    atracurium decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                    droperidol increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • echothiophate iodide

                    echothiophate iodide increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • fesoterodine

                    atracurium and fesoterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • flavoxate

                    atracurium and flavoxate both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • fludrocortisone

                    atracurium, fludrocortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • fluphenazine

                    atracurium decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    fluphenazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • galantamine

                    galantamine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • glycopyrrolate inhaled

                    atracurium and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • haloperidol

                    atracurium decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                    haloperidol increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • henbane

                    atracurium and henbane both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • homatropine

                    atracurium and homatropine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • huperzine A

                    huperzine A increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • hydrocortisone

                    atracurium, hydrocortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • hyoscyamine

                    atracurium and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • hyoscyamine spray

                    atracurium and hyoscyamine spray both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • iloperidone

                    atracurium decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                    iloperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • imipramine

                    atracurium and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • incobotulinumtoxinA

                    atracurium increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Neuromuscular blockers may enhance the effects of prabotulinumtoxinA. Closely monitor for increased neuromuscular blockade.

                  • ipratropium

                    atracurium and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • lofepramine

                    atracurium and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • loxapine

                    atracurium decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

                    loxapine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • loxapine inhaled

                    loxapine inhaled increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                    atracurium decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

                  • magnesium sulfate

                    magnesium sulfate increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.

                  • magnesium supplement

                    magnesium supplement, atracurium. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.

                  • maprotiline

                    atracurium and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • meclizine

                    atracurium and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • methscopolamine

                    atracurium and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • methylprednisolone

                    atracurium, methylprednisolone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • neostigmine

                    neostigmine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • nortriptyline

                    atracurium and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • olanzapine

                    atracurium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

                    olanzapine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • oliceridine

                    oliceridine, atracurium. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

                  • onabotulinumtoxinA

                    atracurium and onabotulinumtoxinA both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • orphenadrine

                    atracurium and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • oxybutynin

                    atracurium and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • oxybutynin topical

                    atracurium and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • oxybutynin transdermal

                    atracurium and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • oxycodone

                    oxycodone increases effects of atracurium by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Oxycodone may enhance the neuromuscular blocking action of true skeletal muscle relaxants and produce an increased degree of respiratory depression.

                  • paliperidone

                    atracurium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                    paliperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • pancuronium

                    atracurium and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • perphenazine

                    atracurium decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    perphenazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • physostigmine

                    physostigmine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • pilocarpine

                    pilocarpine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • pimozide

                    atracurium decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

                    pimozide increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • pralidoxime

                    atracurium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • prednisolone

                    atracurium, prednisolone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • prednisone

                    atracurium, prednisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • prochlorperazine

                    atracurium decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    prochlorperazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • promethazine

                    atracurium decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    promethazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • propantheline

                    atracurium and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • protriptyline

                    atracurium and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • pyridostigmine

                    pyridostigmine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • quetiapine

                    atracurium decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

                    quetiapine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • rapacuronium

                    atracurium and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • rimabotulinumtoxinB

                    atracurium, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

                  • risperidone

                    atracurium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                    risperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • rocuronium

                    atracurium and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • scopolamine

                    atracurium and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • sodium sulfate/?magnesium sulfate/potassium chloride

                    sodium sulfate/?magnesium sulfate/potassium chloride increases effects of atracurium by Other (see comment). Use Caution/Monitor. Comment: Magnesium may potentiate the effects of the neuromuscular blocking agents.

                  • sodium sulfate/potassium sulfate/magnesium sulfate

                    sodium sulfate/potassium sulfate/magnesium sulfate increases effects of atracurium by Other (see comment). Use Caution/Monitor. Comment: Magnesium may potentiate the effects of the neuromuscular blocking agents.

                  • solifenacin

                    atracurium and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • succinylcholine

                    succinylcholine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                  • thioridazine

                    atracurium decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    thioridazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • thiothixene

                    atracurium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

                    thiothixene increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • tiotropium

                    atracurium and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • tobramycin inhaled

                    tobramycin inhaled increases effects of atracurium by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Aminoglycosides may aggravate muscle weakness because of a curare-like effect.

                  • tolterodine

                    atracurium and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • trazodone

                    atracurium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • triamcinolone acetonide injectable suspension

                    atracurium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

                  • trifluoperazine

                    atracurium decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                    trifluoperazine increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • trimipramine

                    atracurium and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • trospium chloride

                    atracurium and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • vecuronium

                    atracurium and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

                  • ziprasidone

                    atracurium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

                    ziprasidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                  • zotepine

                    atracurium decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                    atracurium decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

                  Minor (41)

                  • acetazolamide

                    acetazolamide decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • amlodipine

                    amlodipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • carbamazepine

                    carbamazepine decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • clevidipine

                    clevidipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • clonazepam

                    clonazepam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • desipramine

                    atracurium and desipramine both decrease cholinergic effects/transmission. Minor/Significance Unknown.

                  • diazepam

                    diazepam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • diltiazem

                    diltiazem increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • dimenhydrinate

                    dimenhydrinate increases toxicity of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

                  • donepezil

                    donepezil decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • eslicarbazepine acetate

                    eslicarbazepine acetate decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • ethosuximide

                    ethosuximide decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • felbamate

                    felbamate decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • felodipine

                    felodipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • fosphenytoin

                    fosphenytoin decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • gabapentin

                    gabapentin decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • gabapentin enacarbil

                    gabapentin enacarbil decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • galantamine

                    galantamine decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • isradipine

                    isradipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • lacosamide

                    lacosamide decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • lamotrigine

                    lamotrigine decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • levetiracetam

                    levetiracetam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • lithium

                    lithium increases effects of atracurium by unknown mechanism. Minor/Significance Unknown.

                  • lorazepam

                    lorazepam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • methsuximide

                    methsuximide decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • nicardipine

                    nicardipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • nifedipine

                    nifedipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • nisoldipine

                    nisoldipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • oxcarbazepine

                    oxcarbazepine decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • phenobarbital

                    phenobarbital decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • phenytoin

                    phenytoin decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • primidone

                    primidone decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • quinidine

                    quinidine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown.

                  • rufinamide

                    rufinamide decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • sevoflurane

                    sevoflurane increases levels of atracurium by pharmacodynamic synergism. Minor/Significance Unknown.

                  • thiamine

                    thiamine increases effects of atracurium by unspecified interaction mechanism. Minor/Significance Unknown.

                  • tiagabine

                    tiagabine decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • topiramate

                    topiramate decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • valproic acid

                    valproic acid decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

                  • verapamil

                    verapamil increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

                  • zonisamide

                    zonisamide decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

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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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                  Images

                  BRAND FORM. UNIT PRICE PILL IMAGE
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial
                  atracurium intravenous
                  -
                  		10 mg/mL vial

                  Copyright © 2010 First DataBank, Inc.

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                  Patient Handout

                  Patient Education
                  atracurium intravenous

                  NO MONOGRAPH AVAILABLE AT THIS TIME

                  USES: Consult your pharmacist.

                  HOW TO USE: Consult your pharmacist.

                  SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                  PRECAUTIONS: Consult your pharmacist.

                  DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

                  OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                  NOTES: No monograph available at this time.

                  MISSED DOSE: Consult your pharmacist.

                  STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                  Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.

                  IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                  Formulary

                  FormularyPatient Discounts

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

                  To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                  Create Your List of Plans

                  Adding plans allows you to:

                  • View the formulary and any restrictions for each plan.
                  • Manage and view all your plans together – even plans in different states.
                  • 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.

                  View explanations for tiers and restrictions
                  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.
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