ATRACURIUM BESYLATE

Indications & Dose:

Neuromuscular blockade (short to intermediate duration) for surgery and intubation

• INITIALLY BY INTRAVENOUS INJECTION

Adult: Initially 300–600 micrograms/kg, then (by intravenous injection) 100–200 micrograms/kg as required, alternatively (by intravenous injection) initially 300–600 micrograms/kg, followed by (by intravenous infusion) 300–600 micrograms/kg/ hour

Neuromuscular blockade during intensive care

• INITIALLY BY INTRAVENOUS INJECTION

Adult: Initially 300–600 micrograms/kg, initial dose is optional, then (by intravenous infusion) 270– 1770 micrograms/kg/hour; (by intravenous infusion) usual dose 650–780 micrograms/kg/hour

DOSES AT EXTREMES OF BODY-WEIGHT

To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal bodyweight. 

Contraindications:

Hypersensitivity to atracurium besylate. 

OVERDOSE AND TREATMENT

Overdose causes prolonged respiratory depression or apnea and CV collapse. Sudden histamine release also may occur. A peripheral nerve stimulator is recommended to monitor response and to determine the nature and degree of neuromuscular block. Maintain an adequate airway and manual or mechanical ventilation until patient can maintain respiration unassisted.

Give cholinesterase inhibitors, such as edrophonium, neostigmine, or pyridostigmine, to reverse neuromuscular blockade. Give atropine or glycopyrrolate to counteract muscarinic adverse effects of cholinesterase inhibitors. Monitor vital signs at least every 15 minutes until patient is stable, and then every 30 minutes for next 2 hours.

Observe airway until patient has fully recovered from drug effects. Note rate, depth, and pattern of respirations. 

Side Effects:

Cautions:

 Should be administered only with adequate general anaesthesia and under close monitor of an experienced anaesthetist and with adequate facility for endotracheal intubation and artificial ventilation.

Precautions:

Severe cardiovascular disease, severe electrolyte imbalance, myasthenia gravis, long term infusion. It should be administered with adequate general anaesthesia.

PREGNANCY & BREAST-FEEDING: Use with caution.

OLD AGE: May be used.

Interaction:

Drug

Thiazide diuretics:  Cause hypokalaemia which enhances the neuromuscular blockade.

Enflurane, Isoflurane, Halothane, Aminoglycosides. Polypeptide antibiotics (bacitracin, capreomycin, colistimethate, polymyxin B), Clindamycin, Lincomycin, Lithium, Verapamil, Trimethaphan,  Procainamide and

Quinidine: Enhance the neuromuscular blockade.

Magnesium salts: Reversal of neuromuscu-lar blockade unsatisfactory therefore dose of Atracurium Besylate should be lowered.

Other muscular relaxants: May have both synergistic and antagonist effect.

Phenytoin and Theophylline: Resistance to         or reversal of neuromuscular blockade of atracurium.

Succinylcholine: Enhances atracurium induced neuromuscular blockade. 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CV: bradycardia, flushing, hypotension, tachycardia.

Respiratory: bronchospasm, dyspnea, increased bronchial secretions, laryngospasm, prolonged dose-related apnea, wheezing.

Skin: erythema, pruritus, rash, urticaria

Other: anaphylaxis.

Effects on lab test results

None reported.

Patient And Carer Advice: