Formulary
Atracurium besilate: Indications, Dosing, Side Effects and Interactions
Atracurium besilate clinical drug profile including indications, dosing, side effects, cautions and interactions.
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Atracurium besilate: Indications, Dosing, Side Effects and Interactions
Atracurium besilate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Neuromuscular blockade (short to intermediate duration) for surgery for atracurium besilate**
- **Neonate** (Initially by intravenous injection): Initially 300-500 micrograms/kg, followed by (by intravenous injection) 100-200 micrograms/kg, repeated if necessary, alternatively (by intravenous infusion) 300-400 micrograms/kg/hour, adjusted according to response.
- **Child** (Initially by intravenous injection): Initially 300-600 micrograms/kg, then (by intravenous injection) 100-200 micrograms/kg, repeated if necessary, alternatively (by intravenous injection) initially 300-600 micrograms/kg, followed by (by intravenous infusion) 300-600 micrograms/kg/hour, adjusted according to response.
**Neuromuscular blockade during intensive care for atracurium besilate**
- **Neonate** (Initially by intravenous injection): Initially 300-500 micrograms/kg, followed by (by intravenous injection) 100-200 micrograms/kg, repeated if necessary, alternatively (by intravenous infusion) 300-400 micrograms/kg/hour, adjusted according to response, higher doses may be necessary.
- **Child** (Initially by intravenous injection): Initially 300-600 micrograms/kg, initial dose is optional, then (by intravenous infusion) 270-1770 micrograms/kg/hour; (by intravenous infusion) usual dose 650-780 micrograms/kg/hour.
Cautions
For all non-depolarising neuromuscular blocking drugs Burns (resistance can develop, increased doses may be required); cardiovascular disease (reduce rate of administration); electrolyte disturbances (response unpredictable); fluid disturbances (response unpredictable); hypothermia (activity prolonged, lower doses required); myasthenia gravis (activity prolonged, lower doses required); neuromuscular disorders (response unpredictable)
Side effects
For all non-depolarising neuromuscular blocking drugs Common or very common Flushing; hypotension Uncommon Bronchospasm; hypersensitivity; skin reactions; tachycardia Rare or very rare Circulatory collapse; muscle weakness (after prolonged use in intensive care); myopathy (after prolonged use in intensive care); shock Side-effects For atracurium besilate Rare or very rare Cardiac arrest Frequency not known Seizure Side-effects, further information Hypotension, skin flushing, and bronchospasm is associated with histamine release. Manufacturer advises minimising effects of histamine release by administering over 1 minute in patients with cardiovascular disease or sensitivity to hypotension.
Interactions
**Other interactions (4):**
- Concomitant use of inhalation anaesthetics such as halothane, isoflurane or enflurane may increase the neuromuscular block produced by atracurium besilate.
- As with all non-depolarising neuromuscular blocking agents, non-depolarising neuromuscular block may be increased and/or extended by interaction with: - antibiotics , including the aminoglycosides,...
- Such medicines include various antibiotics, beta-blockers (propranolol, oxprenolol), antiarrhythmics (procainamide, quinidine), anti-rheumatic agents (chloroquine, penicillamine), trimetaphan,...
- The onset of non-depolarising neuromuscular block is likely to be lengthened and the duration of block shortened in patients receiving long-term anticonvulsant therapy (phenytoin, carbamazepine).
Pregnancy
For all non-depolarising neuromuscular blocking drugs Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts.
Breast feeding
For all non-depolarising neuromuscular blocking drugs Non-depolarising neuromuscular blocking drugs are ionised at physiological pH and are unlikely to be present in milk in significant amounts. Breast-feeding may be resumed once the mother has recovered from neuromuscular block.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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