Dosing and uses of Tracrium (atracurium)
Adult dosage forms and strengths
injectable solution
- 10mg/mL
Endotracheal Intubation, Mechanical Ventilation
Calculate dose based on ideal body weight
0.4-0.5 mg/kg IVP over 60 seconds, then 0.08-0.1 mg/kg 20-45 minutes after initial dose to maintain neuromuscular block, repeat maintenance dose q15-25min PRN Or
Continuous infusion: 0.005-0.01 mg/kg/min IV (ranges from 0.002-0.015 mg/kg/min) Or
0.2-0.4 mg/kg IVP if following succinylcholine for intubation
Other Information
Reduce dose if given with general anesthetics that potentiate its activity (eg, isoflurane)
Other Indications & Uses
Skeletal muscle relaxation during surgery
Pediatric dosage forms and strengths
injectable solution
- 10mg/mL
Endotracheal Intubation, Mechanical Ventilation
>2 years old: Same as adult
1 month old - 2 years old: 0.3-0.4 mg/kg IVP under halothane anesthesia
Maintenance dose: Children may need more frequent maint doses than adult
<1 month old: Safety and efficacy not established
Tracrium (atracurium) adverse (side) effects
1-10%
Skin flush (5%)
<1%
Erythema (0.6%)
Wheezing (0.2%)
Increased bronchial secretions (0.2%)
Pruritus (0.2%)
Urticaria (0.1%)
Postmarketing Reports
Wheals
Erythema at injection site
Bronchospasm (0.01%)
Cyanosis (0.001%)
Changes in heart rate (0.6-2.1%)
Mean arterial pressure (1.9%)
Diastolic arterial pressure changes
Systemic vascular resistance changes
Cardiac index changes
Cardiac output changes
Cardiac arrest (0.001%)
CAUTION: adequate ventilatory support mandatory, may experience resistance with >25% TBSA burns, may experience incr sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)
Warnings
Contraindications
Lack of ventilatory support, neuromuscular disease
Cautions
Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent
Closely monitor pts w/: bronchogenic carcinoma, dehydration, electrolyte imbalance, hypotension, hypothermia, myasthenia gravis, pulmonary disease
Pregnancy and lactation
Pregnancy category: C
Lactation: excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Tracrium (atracurium)
Half-Life:
Alpha: 2-3.4 min
Beta: averages 20 min
Other Information
Onset: 2-2.5 min; may be slightly delayed in patients with renal failure
Duration: 20-35 min
Protein Bound: 82%
Vd: 160 mL/kg (range: 120-188 mL/kg)
Metabolism: to laudanoside by non-enzymatic cleavage independent of hepatic/renal function
Excretion: principally in urine & also in feces via biliary elimination
Mechanism of action
Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist
Administration
IV Compatibilities
Solution: D5/NS, D5W(?), NS(?)
Additive: bretylium, cimetidine, ciprofloxacin, dobutamine, dopamine, esmolol, gentamicin, isoproterenol, lidocaine, morphine, KCl, procainamide, vancomycin
Syringe: alfentanil, fentanyl, midazolam, sufentaniL
Y-site: amiodarone, cefazolin, cefuroxime, cimetidine, clarithromycin, dobutamine, dopamine, epinephrine, esmolol, etomidate, fenoldopam, fentanyl, gentamicin, heparin, Hextend, hydrocortisone, isoproterenol, lorazepam, midazolam, milrinone, morphine, nitroglycerin, ranitidine, Na nitroprusside, trimethoprim/sulfamethoxazole, vancomycin
IV Incompatibilities
Solution: Lr
Additive: aminophylline, cefazolin, heparin, quinidine gluconate, ranitidine, sodium nitroprusside
Syringe: alkaline solutions
Y-site: diazepam, propofol(?), thiopentaL
IV Preparation
Add to an empty Viaflex bag & infuse undiluted (10 mg/mL); however, if necessary, may be diluted in D5W, NS or dextrose-saline combinations
Dilution in LR not recommended
IV Administration
Not for IM injection due to tissue irritation
May be given undiluted as bolus injection
Administration via infusion requires use of an infusion pump
Use infusion solutions within 24 hr of preparation
Storage
Refrigerate
Unstable in alkaline solutions
