Atracurium

Class: Neuromuscular Blocking Agents
VA Class: MS200
Chemical Name: 2,2′- [1,5-Pentanediylbis [oxy(3-oxo-3,1-propanediyl)]]bis[1-[(3,4-dimethoxyphenyl)methyl] -1,2,3,4-tetrahydro-6,7-dimethoxy-2-methylisoquinolinium] dibenzenesulfonate
Molecular Formula: C₆₅H₈₂N₂O₁₈S₂
CAS Number: 64228-81-5

Medically reviewed by Drugs.com on Oct 12, 2021. Written by ASHP.

Introduction

Nondepolarizing neuromuscular blocking agent; benzylisoquinolone.

Uses for Atracurium

Skeletal Muscle Relaxation

Production of skeletal muscle relaxation during surgery after general anesthesia has been induced.

Facilitation of endotracheal intubation; however, a neuromuscular blocking agent with a rapid onset of action (e.g., succinylcholine, rocuronium) generally preferred in emergency situations when rapid intubation is required.

Also has been used to facilitate mechanical ventilation in the ICU. Has been given as a continuous IV infusion for up to 10 days in this setting. Whenever neuromuscular blocking agents are used in the ICU, consider benefits versus risks of such therapy and assess patients frequently to determine need for continued paralysis. (See Intensive Care Setting under Cautions.)

Compared with other neuromuscular blocking agents, atracurium has an intermediate onset and duration of action; exhibits minimal cardiovascular effects; and has minimal, if any, cumulative effects. Because elimination is not dependent on renal or hepatic pathways, may be particularly useful in patients with hepatic or renal dysfunction.

Atracurium Dosage and Administration

General

Dispensing and Administration Precautions

• Facilities and personnel necessary for intubation, administration of oxygen, and respiratory support should be immediately available. (See Boxed Warning.)

• Take special precautions (e.g., segregate storage, limit access, affix warning labels to storage containers and final administration containers) to ensure that the drug is not administered without adequate respiratory support. Institute for Safe Medication Practices (ISMP) recommends the following wording on auxiliary labels: “Warning: Paralyzing agent—causes respiratory arrest—patient must be ventilated.”

• Assess neuromuscular blockade and recovery with a peripheral nerve stimulator to accurately monitor the degree of muscle relaxation, determine need for additional doses, and minimize possibility of overdosage. (See Administration Precautions under Cautions.)

• To avoid patient distress, administer in conjunction with adequate analgesia and sedation, and only after unconsciousness has been induced.

• A reversal agent should be readily available in the event of a failed intubation or to accelerate neuromuscular recovery after surgery. (See Reversal of Neuromuscular Blockade under Dosage an...