Atracurium

Generic name
Atracurium
Brand name
ATC Code
M03AC04
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Atracurium

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

The volume of distribution is greater in neonates than in older children. For the same dose in neonates and in older children, the concentration at the myoneural junction will be lower in neonates.

Elimination is independent of hepatic and renal function.

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Neuromuscular blockade
  • Intravenous
    • Term neonate
      • Initial dose: 0.3 mg/kg/dose, bolus.
      • Maintenance dose: 0.3 - 0.6 mg/kg/hour, continuous infusion.
        • When atracurium is used only for intubation, the starting dose is sufficient.
        • Titrate maintenance dose based on the Train of Four (TOF) test
        • Alternative intermittent maintenance dose: 0.3 - 0.6 mg/kg/dose, as a bolus. Repeat as necessary based on the Train of Four (TOF) test
    • 1 month up to 18 years
      [2]
      • Initial dose: 0.5 mg/kg/dose, bolus.
      • Maintenance dose: 0.3 - 0.6 mg/kg/hour, continuous infusion.
        • When atracurium is used only for intubation, the starting dose is sufficient.
        • Titrate maintenance dose based on the Train of Four (TOF) test
        Alternative intermittent maintenance dose: 0.3-0.6 mg/kg/dose as a bolus. Repeat as necessary based on the Train of Four (TOF) test.

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Histamine release.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

Mastocytosis (mast cell activation syndrome)

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Monitor neuromuscular function. The duration of action for muscle relaxants is so variable that relaxation measurement should be considered before extubation and antagonized if necessary. 

Cross hypersensitivity - including from other groups - is possible. This may be based on the excipients but also on the active ingredient. Advice is to consult a pediatric allergist in case of a suspected allergic reaction to a muscle relaxant and with the request to also test for safety of alternative muscle relaxants.

Use caution in cases of (suspected) increased sensitivity to histamine release based on history

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Choline derivatives
M03AB01
Other quaternary ammonium compounds
M03AC03

References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. Aspen Pharma Trading Limited, SmPC Tracrium (RVG 09981) 25-07-2017, www.geneesmiddeleninformatiebank.nl

Changes

Therapeutic Drug Monitoring


Overdose