indication

For use, as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

pharmacology

Atracurium is a nondepolarizing skeletal muscle relaxant. Atracurium can be used most advantageously if muscle twitch response to peripheral nerve stimulation is monitored to assess degree of muscle relaxation. The duration of neuromuscular block produced by Atracurium is approximately one third to one half the duration of block by d-tubocurarine, metocurine, and pancuronium at initially equipotent doses. As with other nondepolarizing neuromuscular blockers, the time to onset of paralysis decreases and the duration of maximum effect increases with increasing doses of Atracurium. Repeated administration of maintenance doses of Atracurium has no cumulative effect on the duration of neuromuscular block if recovery is allowed to begin prior to repeat dosing. Moreover, the time needed to recover from repeat doses does not change with additional doses. Repeat doses can therefore be administered at relatively regular intervals with predictable results.

mechanism of action

Atracurium antagonizes the neurotransmitter action of acetylcholine by binding competitively with cholinergic receptor sites on the motor end-plate. This antagonism is inhibited, and neuromuscular block reversed, by acetylcholinesterase inhibitors such as neostigmine, edrophonium, and pyridostigmine.

toxicity

Excessive doses can be expected to produce enhanced pharmacological effects. Overdosage may increase the risk of histamine release and cardiovascular effects, especially hypotension.

half life

The elimination half-life is approximately 20 minutes.

drug interactions

Amikacin: The agent increases the effect of muscle relaxant

Aminophylline: Theophylline decreases the effect of muscle relaxant

Azathioprine: The agent decreases the effect of the muscle relaxant

Carbamazepine: Decreases the effect of muscle relaxant

Clindamycin: The agent increases the effect of muscle relaxant

Colistimethate: Colistimethate may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. If possible, avoid concomitant use of these products. Monitor for deeper, prolonged neuromuscular-blocking effects (respiratory paralysis) in patients receiving concomitant neuromuscular-blocking agents and polymyxin antibiotics (e.g., colistimethate, polymyxin B).

Fosphenytoin: Phenytoin decreases the effect of muscle relaxant

Gentamicin: The agent increases the effect of muscle relaxant

Lincomycin: The agent increases the effect of muscle relaxant

Mercaptopurine: The agent dereases the effect of the muscle relaxant

Netilmicin: The agent increases the effect of muscle relaxant

Oxtriphylline: Theophylline decreases the effect of muscle relaxant

Phenytoin: Phenytoin decreases the effect of the muscle relaxant

Piperacillin: The agent increases the effect of the muscle relaxant

Quinidine: The quinine derivative increases the effect of the muscle relaxant

Quinine: The quinine derivative increases the effect of the muscle relaxant

Theophylline: Theophylline decreases the effect of the muscle relaxant

Tobramycin: The agent increases the effect of the muscle relaxant