ATRACADE INJECTION

Indications

• Facilitation of tracheal intubation
• Muscle relaxation during surgical procedures
• Adjunct to general anaesthesia

Dosage

Children: Refer to BNF for Children for specific dosing information, as it is essential to tailor dosing to the child's age, weight, and clinical condition.

Adults: Refer to BNF for specific dosing information as it varies based on the clinical situation and patient response.

Mechanism of action

Atracurium works by competitively inhibiting the action of acetylcholine at the neuromuscular junction. This blockade prevents the transmission of nerve impulses to the skeletal muscles, leading to muscle paralysis. The drug undergoes a process called ester hydrolysis and is metabolized by plasma esterases and non-specific plasma enzymes, which contribute to its clearance and make it less dependent on renal or hepatic function.

Pharmacodynamics

The onset of action for atracurium usually occurs within 2 to 4 minutes after intravenous administration, with a peak effect at about 20 to 35 minutes. The duration of action is typically around 20 to 35 minutes, depending on the dose and the individual patient response. Atracurium may cause side effects such as histamine release, resulting in hypotension and bronchospasm, particularly in sensitive individuals.

Pharmacokinetics

Atracurium is administered intravenously and is rapidly distributed throughout the body. It has a volume of distribution of approximately 0.2 to 0.4 L/kg. The clearance of atracurium is influenced by its unique metabolic pathway, which involves spontaneous degradation and hydrolysis by non-specific plasma esterases. The half-life ranges from 20 to 35 minutes. Due to its unique metabolism, atracurium can be safely used in patients with compromised renal or liver function.

Contra-indications

• Hypersensitivity to atracurium or any of its excipients
• Myasthenia gravis
• Severe respiratory depression

Adverse effects

• Hypotension
• Respiratory depression
• Allergic reactions including anaphylaxis
• Prolonged neuromuscular block
• Muscle weakness
• Tachycardia
• Bradycardia
• Histamine release leading to flushing or bronchospasm

Interactions

• Aminoglycoside antibiotics may potentiate neuromuscular block
• Certain inhalational anesthetics can enhance the neuromuscular blocking effect
• Calcium channel blockers may increase the neuromuscular blocking effects of atracurium
• Anticonvulsants may affect the metabolism of atracurium

Precautions

• Caution in patients with cardiovascular disorders
• Monitor patients with neuromuscular disorders
• Careful dosing in elderly patients or those with renal or hepatic impairment
• Use with caution in patients receiving other neuromuscular blockers

Pregnancy

Atracurium is classified as Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Caution is advised as atracurium is not well studied in breastfeeding. The decision to continue or discontinue breastfeeding should consider the importance of the drug to the mother.

Storage

Store at room temperature, protect from light. Do not freeze. Discard any unused solution after a specified period.

Formulations

• Injection solution: 10 mg/mL in vials