Atracurium besilate

CLINICAL USE

Non-depolarising muscle relaxant of short to medium duration

DOSE IN NORMAL RENAL FUNCTION

Initially: 300–600 mcg/kg, depending on duration of full block required

Maintenance: 100–200 mcg/kg as required or

IV infusion

: 300–600 mcg/kg/hour

Intensive care: Initially, 300–600 mcg/kg then by infusion: 4.5–29.5 mcg/kg/minute (usual dose: 11–13 mcg/kg/minute)

PHARMACOKINETICS

Molecular weight :1243.5

%Protein binding :82

%Excreted unchanged in urine : 0

Volume of distribution (L/kg) :0.16

half-life – normal/ESRD (hrs) :Approx 20 minutes/unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in normal renal function

HD :Unlikely to be dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Unlikely to be dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced effect with volatile liquid general anaesthetics

Anti-arrhythmics: procainamide enhances muscle relaxant effect

Antibacterials: aminoglycosides, clindamycin, polymyxin, piperacillin enhance effect of atracurium

Atracurium enhances the neuromuscular block produced by botulinum toxin (risk of toxicity)

ADMINISTRATION

Reconstition

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Route

IV bolus,

IV infusion Rate of Administration

IV infusion : Initial bolus dose of 0.3–0.6 mg/kg over 60 seconds, then administer as a continuous infusion at rates of 0.3–0.6 mg/kg/hour

Comments

Stable in sodium chloride 0.9% for 24 hours, and glucose 5% for 8 hours when diluted to concentrations of 0.5 mg/mL or above

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