Atracurium besilate

Intravenous
Facilitate endotracheal intubation

Patient with clinically significant CV disease or those unusually sensitive to falls in arterial blood pressure (e.g. hypovolaemic): Initial doses must be administered over 60 seconds.

IV infusion: Dilute to a concentration of 0.5 mg/mL with dextrose 5% inj, NaCl 0.9% solution, Ringer’s inj, or Hartmann’s solution for inj.

Incompatible with alkaline solutions (e.g. thiopental Na).

Patient with previous anaphylactic reaction to other neuromuscular blockers; clinically significant CV disease; conditions that may antagonize neuromuscular blockade (e.g. respiratory alkalosis, hypercalcaemia, demyelinating lesions, peripheral neuropathies, denervation, muscle trauma); conditions that may potentiate neuromuscular blockade (e.g. electrolyte abnormalities, metabolic and respiratory acidosis, Eaton-Lambert syndrome, myasthenia gravis, neuromuscular diseases); hypovolaemia, asthma, burn injury. Obese or immobilised patients. Children and elderly. Pregnancy and lactation.

Significant: Bradycardia, prolonged paralysis.
Cardiac disorders: Transient tachycardia.
General disorders and administration site conditions: Inj site reactions.
Musculoskeletal and connective tissue disorders: Myopathy, muscle weakness.
Nervous system disorders: Seizures.
Respiratory, thoracic and mediastinal disorders: Bronchospasm, dyspnoea, wheezing.
Skin and subcutaneous tissue disorders: Erythema, urticaria.
Vascular disorders: Hypotension, flushing.
Potentially Fatal: Severe anaphylactic reactions.

IV/Parenteral: C

Monitor vital signs (e.g. heart and respiratory rate, blood pressure); degree of muscle paralysis (e.g. ventilator asynchrony, shivering, presence of spontaneous movement).

Symptoms: Prolonged muscle paralysis and hypotension. Management: Maintain a patient airway and assisted positive pressure ventilation until spontaneous respiration is adequate. Once evidence of spontaneous recovery is present, administer anticholinesterase agents (e.g. neostigmine, pyridostigmine) with an anticholinergic agent (e.g. atropine, glycopyrrolate) to hasten recovery. May provide CV support by proper positioning, administration of fluids and vasopressors, if necessary.

Increased neuromuscular blocking effects with inhalational anaesthetics (e.g. enflurane, isoflurane, halothane), antibiotics (e.g. aminoglycosides, polymyxins, tetracyclines, clindamycin, lincomycin), antiarrhythmics (e.g. quinidine, procainamide, lidocaine, propranolol, Ca channel blockers), diuretics (e.g. furosemide, acetazolamide), ganglion blocking agents (e.g. hexamethonium), ketamine, Mg salts, and lithium salts.

Description:
Mechanism of Action: Atracurium besilate is a highly selective neuromuscular blocking agent. It competes with acetylcholine for receptors on the motor end-plate of neuromuscular junction resulting in neural transmission blockade.
Onset: 2-3 minutes.
Duration: 20-35 minutes.
Pharmacokinetics:
Distribution: Crosses the placenta (in small amounts). Volume of distribution: 120-188 mL/kg. Plasma protein binding: Approx 82%.
Metabolism: Converted to laudanosine and other metabolites via spontaneous degradation via Hofmann elimination; undergoes non-specific enzymatic ester hydrolysis.
Excretion: Via urine (<5%); bile. Elimination half-life: Approx 20 minutes.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 47320, Atracurium Besylate. https://pubchem.ncbi.nlm.nih.gov/compound/Atracurium-Besylate. Accessed May 28, 2024.

Intact ampoule: Store between 2-8°C. Do not freeze. Protect from light. Diluted solution: Store up to 30°C; stability period may vary according to diluent used (refer to detailed product guideline).

Muscle Relaxants

M03AC04 - atracurium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

Anon. Atracurium. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 06/05/2024.

Atracurium Besilate 10 mg/mL Solution for Injection/Infusion (Aspen Pharma Trading Limited). MHRA. https://products.mhra.gov.uk. Accessed 06/05/2024.

Atracurium Besylate Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/05/2024.

Atracurium. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/05/2024.

Buckingham R (ed). Atracurium Besilate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/05/2024.

Joint Formulary Committee. Atracurium Besilate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/05/2024.

Pharmacy Retailing (NZ) Ltd t/a Healthcare Logistics. Tracrium 10 mg/mL Injections (2.5 mL and 5.0 mL) data sheet May 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 06/05/2024.

Tracrium Injection (Aspen Medical Products Malaysia Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 06/05/2024.