Without a Prescription
Atracurium is prescribed as an adjunct to general anaesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. It is a nondepolarising neuromuscular blocking agent with an intermediate duration of action, administered intravenously to produce skeletal muscle relaxation.
Atracurium should be prescribed only by those skilled in the management of artificial respiration and only when facilities are immediately available for endotracheal intubation and for providing adequate ventilation support, including the administration of oxygen under positive pressure and the elimination of carbon dioxide. The clinician must be prepared to assist or control ventilation, and anticholinesterase agents should be immediately available for reversal of neuromuscular blockade. Atracurium has the potential to cause histamine release and therefore, there is a possibility of life-threatening anaphylactic reactions. For this reason it is essential that appropriate resuscitative equipment be immediately available. Atracurium has no known effect on consciousness, pain threshold, or cerebration. It should be prescribed only with adequate anaesthesia. It should not be given by intramuscular administration. Atracurium has an acid pH and therefore should not be mixed with alkaline solutions (eg barbiturate solutions) in the same syringe or administered simultaneously during intravenous infusion through the same needle.
When a small vein is selected as the injection site, Atracurium should be flushed through the vein with physiological saline after injection. When other anaesthetic drugs are administered through the same indwelling needle or cannula as Atracurium, it is important that each drug is flushed through with an adequate volume of physiological saline.
Atracurium may have profound effects in patients with Myasthenia gravis, Eaton-Lambert syndrome, or other neuromuscular diseases in which potentiation of nondepolarising agents has been noted. A reduced dosage of atracurium and the use of a peripheral nerve stimulator for assessing neuromuscular blockade are especially important in these patients. Similar precautions should be taken in patients with severe electrolyte disorders or carcinomatosis. The safety of atracurium has not been established in patients with bronchial asthma. Atracurium does not have significant vagal or ganglion blocking properties in the recommended dosage range. In pregnant women category C Atracurium crosses the placenta, but there have been no demonstrated adverse effects in the foetus or newborn infant. It is not known whether muscle relaxants administered during vaginal delivery have immediate or delayed adverse effects on the foetus or increase the likelihood that resuscitation of the newborn infant will be necessary. The possibility that a forceps delivery will be necessary may increase. In nursing women it is not known whether Atracurium is excreted in human milk. Safety and effectiveness in children below the age of 1 month have not been established.
During extensive clinical trials atracurium was well tolerated and produced few adverse reactions. As with most neuromuscular blocking agents, the potential exists for adverse reactions suggestive of histamine release in susceptible patients. Most adverse reactions were of little clinical significance unless they were associated with significant hemodynamic changes. Other adverse reactions which have been reported during clinical trials include: Bronchospasm, Tachycardia. Anaphylactoid reactions have been reported rarely.
There is limited experience with atracurium overdosage following parenteral administration. The possibility of iatrogenic over dosage can be minimized by carefully monitoring muscle twitch response to peripheral nerve stimulation. Excessive doses of atracurium are likely to produce symptoms consistent with extensions of the usual pharmacological effects. Over dosage may increase the risk of histamine release and adverse cardiovascular effects, especially hypotension. If cardiovascular support is necessary, this should include proper positioning, fluid administration, and the use of vasopressor agents if necessary. The patient's airway should be maintained, with manual or mechanical ventilation maintained as necessary. The duration of neuromuscular blockade may be prolonged and a peripheral nerve stimulator should be prescribed to monitor recovery. Full sedation will be required since consciousness is not impaired. Recovery may be facilitated by the administration of an anti cholinesterase agent such as neostigmine or pyridostigmine, in conjunction with an anticholinergic agent such as Atropine.
Atracurium should be stored at 2 to 8°C. It is not to be frozen and should be protected from light. Any unused atracurium besylate from opened ampoules should be discarded.
Other Brand Names
In some countries Atracurium may also be known as: