ATRACURIUM BESILATE

Benzylisoquinolinium non-depolarising neuromuscular blocker with intermediate duration of neuromuscular blockade

Dosage Forms

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Solution for injection

10 mg/ml

Uses

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  • Neuromuscular blockade for surgery
  • Neuromuscular blockade during intensive care

Dose and Duration

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Neuromuscular blockade during intubation and surgery
Adult and child above 1 month: by IV injection, initially 0.3–0.6 mg/kg, then 0.1–0.2 mg/kg as required
OR

Initially by IV injection, 0.2–0.6 mg/kg followed by IV in fusion, 0.3–0.6 mg/kg/hour adjusted according to response

Neonate: : initially by IV injection 0.3–0.5 mg/kg followed either by IV injection, 0.1–0.2 mg/kg repeated as necessary or by IV infusion, 0.3–0.4 mg/kg/hour adjusted according to response
Neuromuscular blockade during intensive care
Adult and child above 1 month: by IV injection, initially 0.3–0.6 mg/kg then by IV infusion 0.27–1.77 mg/kg/hour (usual dose 0.65–0.78 mg/kg/hour)
Neonate: initially by IV injection 0.3–0.5 mg/kg followed either by IV injection, 0.1–0.2 mg/kg repeated as necessary or by IV infusion, 0.3–0.4 mg/kg/hour adjusted ac cording to response; higher doses may be necessary

Preparation

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  • Dilute with sodium chloride 0.9%, glucose 5% or ringer’s lactate solution

Contraindications

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  • Hypersensitivity to atracurium

Side Effects

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  • Flushing, transient hypotension, tachycardia, bradycardia, hypertension
  • Injection site reactions
  • Urticaria, itching, anaphylactoid reactions
  • Bronchospasm, wheezing

Interactions

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  • Aminoglycosides, clindamycin, polymixin B (effects of atracurium enhanced)
  • Phenytoin (effect of atracurium reduced by long-term use of atracurium; acute use of phenytoin may increase the effect of atracurium)

Patient Instructions

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  • Do not drive or operate dangerous machinery within 24 hours of administration

Pregnancy

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  • Can be used

Breastfeeding

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  • Can be used (see caution)

Storage

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  • Store in a refrigerator at 2–8oC. Do not freeze
  • Use diluted solutions immediately or store diluted solutions in a refrigerator for not more than 24 hours

⚠️ Caution

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  • Monitor infant if breast feeding is started within 24 hours after administration of atracurium
  • Only use in pregnancy when absolutely necessary
  • Use with caution in patients with hypersensitivity to other neuromuscular blocking drugs due to risk of allergic cross-reactivity
  • Use lower doses in patients with myasthenia gravis or hypothermia
  • In patients with burns, dose increase may be required
  • Use with caution in patients with other neuromuscular disorders and electrolyte imbalances since effect is unpredictable
  • Reduce rate of administration in patients with cardiovascular disease
  • In obesity, dose should be calculated on the basis of ideal body weight to avoid excessive dosage
  • Administer with adequate general anaesthesia or with adequate sedation
  • Do not administer intramuscularly
  • Flush vein with normal saline after administration. If same cannula is used for other medicines, flush the cannula with water for injections or normal saline