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

FDA dosing	Population	Start	Target
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

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

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

Pregnancy Category C; potentially teratogenic in rabbits; use only if potential benefit justifies risk

Lactation Undefined

NO BOXED WARNINGS

Principal riskHistamine release; laudanosine accumulates

Direct muscarinic antagonism0 / 4