atracurium (Rx)

Brand and Other Names:Tracrium
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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

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Interactions

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              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.

              • 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.

              • pilocarpine ophthalmic

                pilocarpine ophthalmic 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) 2021 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.

              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.

              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.