atracurium besilate: clinical use

Prescribing considerations

• Administer only under experienced supervision with facilities for intubation, positive-pressure ventilation and reversal immediately available.
• Ensure adequate general anaesthesia or sedation because atracurium does not impair consciousness or provide analgesia.
• Use neuromuscular monitoring throughout blockade and recovery.
• Exercise particular caution with asthma, atopy, hypovolaemia, significant cardiovascular disease, burns, severe electrolyte disturbance and previous reactions to neuromuscular blockers.
• Response may be markedly increased in myasthenia gravis, Eaton–Lambert syndrome and other neuromuscular disorders.
• Prolonged intensive-care administration has been associated with rare seizures and muscle weakness or myopathy, often with other contributing conditions or medicines.

Contraindications and cautions

• Hypersensitivity to atracurium besilate or any formulation excipient.
• Hypersensitivity to cisatracurium.

Monitoring

• Peripheral nerve stimulation and recovery of neuromuscular function
• Ventilation, oxygenation and airway patency
• Blood pressure and heart rate
• Signs of histamine release, bronchospasm or anaphylaxis

Clinical pharmacology

Atracurium competitively blocks acetylcholine at nicotinic receptors on the motor endplate. It is degraded mainly by temperature- and pH-dependent Hofmann elimination and non-specific ester hydrolysis, so elimination of the parent compound is largely independent of kidney and liver function. Laudanosine is an inactive neuromuscular metabolite that may accumulate during prolonged intensive-care use.

Formulation and product differences

• The selected product is a clear, colourless or faint-yellow intravenous solution supplied in glass ampoules and vials.
• It contains no preservative; inspect for cloudiness or precipitate and discard residue after use.
• Store refrigerated, do not freeze and retain in the outer carton.
• Its acidic formulation must not share a syringe or needle simultaneously with alkaline solutions such as barbiturates.
• The hypotonic solution must not be administered through a blood-transfusion line.

Injection

Route: Parenteral

Strengths: 10 mg/mL