Home Drug Guide Atracurium Besylate

Drug Guide

Generic Name

Atracurium Besylate

Brand Names Tracrium Preservative Free, Tracrium, Atracurium Besylate Preservative Free

Classification

Therapeutic: Skeletal muscle relaxant, non-depolarizing

Pharmacological: Nm-blocker (neuromuscular blocker)

FDA Approved Indications

Facilitation of endotracheal intubation during anesthesia
Muscle relaxation during surgery

Mechanism of Action

Atracurium binds competitively to acetylcholine receptors at the neuromuscular junction, preventing acetylcholine from activating these receptors, leading to muscle relaxation. It undergoes Hoffmann elimination, which is independent of organ function.

Dosage and Administration

Adult: Dose varies based on procedure; typically 0.4-0.5 mg/kg IV for intubation, followed by additional doses as needed.

Pediatric: Dosing similar to adults; specific pediatric dosing depends on weight and clinical situation.

Geriatric: Start with lower doses; monitor closely due to increased sensitivity.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; however, no specific adjustments are usually required due to organ-independent metabolism.

Pharmacokinetics

Absorption: Administered IV, not absorbed via other routes.

Distribution: Widely distributed in body tissues and fluids.

Metabolism: Undergoes Hoffmann elimination and ester hydrolysis; organ-independent.

Excretion: Primarily eliminated via plasma esterases and Hoffman elimination.

Half Life: 20-35 minutes in adults, varies with dose and patient condition.

Contraindications

Known hypersensitivity to atracurium or other components.
History of histamine release reactions.

Precautions

Use cautiously in patients with cardiovascular disease, as histamine release can cause hypotension and bronchospasm.
Monitor for signs of allergic reactions or significant hypotension.

Adverse Reactions - Common

Histamine release leading to flushing, hypotension, bronchospasm (Occasional)
Muscle pain or weakness postoperatively (Rare)

Adverse Reactions - Serious

Anaphylaxis (Rare)
Prolonged paralysis (Rare)

Drug-Drug Interactions

Other neuromuscular blockers (additive effects), aminoglycoside antibiotics, magnesium sulfate, calcium channel blockers

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor neuromuscular function (e.g., Train-of-Four), vital signs, and oxygen saturation.

Diagnoses:

Impaired gas exchange
Risk for ineffective airway clearance
Impaired physical mobility

Implementation: Administer IV carefully, monitor patient response, and have resuscitation equipment available.

Evaluation: Assess muscle strength and respiratory status to determine adequacy of paralysis and recovery.

Patient/Family Teaching

Inform about potential muscle weakness and breathing difficulties.
Report signs of allergic reactions, such as rash, difficulty breathing.
Assure about the temporary nature of muscle relaxation.

Special Considerations

Black Box Warnings:

None specific for atracurium.

Genetic Factors: Genetic variations in plasma cholinesterase can affect metabolism of other agents, but not atracurium.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Persistent paralysis, difficulty breathing, cyanosis.

Treatment: Supportive care with mechanical ventilation, monitor neuromuscular function, may administer cholinesterase inhibitors (e.g., neostigmine) to reverse effects if appropriate.

Storage and Handling

Storage: Store at room temperature, protected from moisture.

Stability: Stable under recommended storage conditions for the labeled shelf life.