Atracurium
TRACRIUM
What it isNon-depolarizing neuromuscular blocker cleared by Hofmann elimination; surgical paralysis.
Why this oneCisatracurium offers the same organ-independent clearance with less histamine release, so it is usually preferred.
What limits itHistamine release causes hypotension and flushing. Laudanosine accumulates with prolonged infusion.
FDA-approved for
- neuromuscular blockade (surgery) (1983)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Neuromuscular blockade (intubation/maintenance during surgery) | Adults | 0.4–0.5 mg/kg IV bolus (0.25–0.35 mg/kg if under steady-state isoflurane/enflurane) | maintenance 0.08–0.10 mg/kg IV q15–25 min | |
| Neuromuscular blockade | Infants 1 mo–2 y (halothane) | 0.3–0.4 mg/kg IV | maintenance PRN | |
| Neuromuscular blockade | Pediatric ≥2 y | Same as adults (no adjustment) | maintenance 0.08–0.10 mg/kg IV |
Renal No dosage adjustment required for renal disease
Hepatic Undefined
Non-cumulative; maintenance doses may be given at regular intervals
Instructions
- IV use only — do NOT give IM
- Do not administer before unconsciousness is induced
- Use a peripheral nerve stimulator to guide dosing
- Reduce dose ~1/3 under steady-state isoflurane/enflurane
- Continuous infusion (OR): 9–10 then 5–9 mcg/kg/min; ICU: 11–13 mcg/kg/min
- Do not mix with alkaline solutions (e.g., barbiturates); do not use Lactated Ringer's as diluent
Available strengths
- inj 10 mg/mL
Cautions
- Histamine release — flushing, hypotension, bronchospasm; use lower dose (0.3–0.4 mg/kg) in cardiovascular disease or history of anaphylactoid reactions/asthma
- Severe anaphylactic/anaphylactoid reactions (can be fatal)
- Reduce dose in neuromuscular disease, severe electrolyte disorders, carcinomatosis
- Long-term ICU use — laudanosine accumulation; rare seizures
- Accidental administration of neuromuscular blockers may be fatal — risk of medication errors
Adverse reactions
- Flushing
- Erythema
- Hypotension
- Tachycardia
- Bradycardia
- Wheezing/bronchial secretions
- Urticaria
- Rare anaphylaxis
- Prolonged or inadequate block
Pregnancy Category C; potentially teratogenic in rabbits; use only if potential benefit justifies risk
Lactation Undefined
Cost
Atracurium (TRACRIUM)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 10 mg/mL | inj | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Atracurium is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
NO BOXED WARNINGS
Principal riskHistamine release; laudanosine accumulates