Atracurium besilate
Atracurium besilate.JPG

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

    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



    See how to identify renal failure stages according to GFR calculation

    See how to diagnose irreversible renal disease

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