Atracurium (Besylate)

The first drug that was found capable of blocking the skeletal neuromuscular junction was curare, which the native hunters of the Amazon in the South America used to paralyze prey. Atracurium is a skeletal muscle relaxant and structural analog of acetylcholine. Atracurium (Besylate) is iso-quinoline non-depolarizing competitive neuromuscular blocking agent. The neuromuscular blocking agents have significantly increased the safety of anesthesia , since less anesthetic is required to produce muscle relaxation.

Atracurium (Besylate) is primarily indicated in conditions like Adjunct to anesthesia, Muscle relaxation, Muscle relaxation during intensive care, Muscle relaxation for surgery or intubation, Neuromuscular blockade.

Atracurium (Besylate) is contraindicated in conditions like Documented Hypersensitivity to drug or component, lack of ventilatory support, neuromuscular disease.

Atracurium (Besylate) produces potentially life-threatening effects which include Anaphylactic reactions, Skin flush, Erythema. which are responsible for the discontinuation of Atracurium (Besylate) therapy.The signs and symptoms that are produced after the acute over dosage of Atracurium (Besylate) include Respiratory muscle paralysis.The symptomatic adverse reactions produced by Atracurium (Besylate) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Histamine release, Bradycardia, Wheezing, Reaction at injection site, Urticaria, pruritis, Wheals, Cyanosis, Increased bronchial secretions.

ATRACURIUM SHOULD BE USED ONLY BY THOSE SKILLED IN AIRWAY MANAGEMENT AND RESPIRATORY SUPPORT. EQUIPMENT AND PERSONNEL MUST BE IMMEDIATELY AVAILABLE FOR ENDOTRACHEAL INTUBATION AND SUPPORT OF VENTILATION, INCLUDING ADMINISTRATION OF POSITIVE PRESSURE OXYGEN. ADEQUACY OF RESPIRATION MUST BE ASSURED THROUGH ASSISTED OR CONTROLLED VENTILATION. ANTICHOLINESTERASE REVERSAL AGENTS SHOULD BE IMMEDIATELY AVAILABLE. DO NOT GIVE ATRACURIUM BESYLATE BY INTRAMUSCULAR ADMINISTRATION. Atracurium has no known effect on consciousness, pain threshold, or cerebration. It should be used only with adequate anesthesia. Atracurium besylate injection, which has an acid pH, should not be mixed with alkaline solutions (e.g., barbiturate solutions) in the same syringe or administered simultaneously during intravenous infusion through the same needle. Depending on the resultant pH of such mixtures, atracurium may be inactivated and a free acid may be precipitated. Atracurium besylate injection 10 mL multiple dose vials contain benzyl alcohol. In neonates, benzyl alcohol has been associated with an increased incidence of neurological and other complications which are sometimes fatal. Atracurium besylate 5 mL single use vials do not contain benzyl alcohol (see PRECAUTIONS, Pediatric Use ).

ATRACURIUM SHOULD BE USED ONLY BY THOSE SKILLED IN AIRWAY MANAGEMENT AND RESPIRATORY SUPPORT. EQUIPMENT AND PERSONNEL MUST BE IMMEDIATELY AVAILABLE FOR ENDOTRACHEAL INTUBATION AND SUPPORT OF VENTILATION, INCLUDING ADMINISTRATION OF POSITIVE PRESSURE OXYGEN. ADEQUACY OF RESPIRATION MUST BE ASSURED THROUGH ASSISTED OR CONTROLLED VENTILATION. ANTICHOLINESTERASE REVERSAL AGENTS SHOULD BE IMMEDIATELY AVAILABLE. DO NOT GIVE ATRACURIUM BESYLATE BY INTRAMUSCULAR ADMINISTRATION. Atracurium has no known effect on consciousness, pain threshold, or cerebration. It should be used only with adequate anesthesia. Atracurium besylate injection, which has an acid pH, should not be mixed with alkaline solutions (e.g., barbiturate solutions) in the same syringe or administered simultaneously during intravenous infusion through the same needle. Depending on the resultant pH of such mixtures, atracurium may be inactivated and a free acid may be precipitated. Atracurium besylate injection 10 mL multiple dose vials contain benzyl alcohol. In neonates, benzyl alcohol has been associated with an increased incidence of neurological and other complications which are sometimes fatal. Atracurium besylate 5 mL single use vials do not contain benzyl alcohol (see PRECAUTIONS, Pediatric Use ).

0.3 to 0.6 mg/ kg (0.45 (0.45)) As recommended. IV — Initial Bolus Dose 0.3 to 0.6 mg/ kg/hr (0.45 (0.45)) As recommended. IV Inf — Maintenance Dose Scraped Dose — An adult patient (17 years of age) unintentionally received an initial dose of 1.3 mg/kg of atracurium besylate. The time from injection to 25% recovery (83 minutes) was approximately twice that observed following maximum recommended doses in adults (35 to 45 minutes). The patient experienced moderate hemodynamic changes (13% increase in mean arterial pressure and 27% increase in heart rate) which persisted for 40 minutes and did not require treatment. The intravenous LD 50 s determined in non-ventilated male and female albino mice and male Wistar rats were 1.9, 2.01 and 1.31 mg/kg, respectively. Deaths occurred within 2 minutes and were caused by respiratory paralysis. The subcutaneous LD 50 determined in non-ventilated male Wistar rats was 282.8 mg/kg. Tremors, ptosis, loss of reflexes and respiratory failure preceded death which occurred 45 to 120 minutes after injection.

0.005 to 0.01 mg/kg.min (0.0075 (0.0075)) As recommended. IV Infusion — As Required 0.3 to 0.6 mg/kg (0.45 (0.45)) As recommended. Intra Venous — As Required Scraped Dose — Three pediatric patients (3 weeks, 4 and 5 months of age) unintentionally received doses of 0.8 mg/kg to 1 mg/kg of atracurium besylate. The time to 25% recovery (50 to 55 minutes) following these doses, which were 5 to 6 times the ED 95 dose, was moderately longer than the corresponding time observed following doses 2 to 2.5 times the atracurium ED 95 dose in infants (22 to 36 minutes). Cardiovascular changes were minimal. Nonetheless the possibility of cardiovascular changes must be considered in the case of overdose.

0.005 to 0.01 mg/kg.min (0.0075 (0.0075)) As recommended. Infusion — Dose for children over 1 month

Drugs which may enhance the neuromuscular blocking action of atracurium include: enflurane; isoflurane; halothane; certain antibiotics, especially the aminoglycosides and polymyxins; lithium; magnesium salts; procainamide; and quinidine. If other muscle relaxants are used during the same procedure, the possibility of a synergistic or antagonist effect should be considered. The prior administration of succinylcholine does not enhance the duration, but quickens the onset and may increase the depth, of neuromuscular block induced by atracurium besylate. Atracurium should not be administered until a patient has recovered from succinylcholine-induced neuromuscular block.

Inj Store in refrigerator. Do not Freeze.