Atracurium Intravenous Infusion for Ventilated Adult Patients

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

• To be used only in a critical care setting for ventilated patients
• Consideration should be given to dosing obese patients based on Ideal body weight, or an adjusted body weight (ref 1)
• As this is a neuromuscular blocker particular care and attention should be focused on the safe storage and distribution of this drug so as to minimise the risk of right patient wrong drug
• This monograph relates ONLY to the use in critical care for paralysis relating to ARDS
• For complete information and guidance refer to the manufacturers SPC on www.medicines.ie
• For Y-site compatibility see below

Available preparations

Atracurium (Tracrium) 25mg in 2.5ml ampoules

Atracurium (Tracrium) 250mg in 25ml ampoules

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9% or Glucose 5% (if required)

Methods of intravenous administration

Bolus intravenous injection

• Administer by rapid intravenous injection
• Administer more slowly over 1 to 2 minutes for patients with significant cardiovascular disease or hypovolaemia (ref 2)

Continuous Intravenous Infusion

• Use undiluted - 500mg in 50ml via a syringe pump

Dose in adults

Intensive care unit paralysis (eg, use for up to 48 hours in patients with early ARDS with PaO2/FiO2 <150, to facilitate mechanical ventilation, or for shivering from therapeutic hypothermia) (unlicensed) (ref 1)

• Initial bolus of 0.4 to 0.5mg/kg, followed by continuous IV infusion of 4 to 20 mcg/kg/minute (0.24 to 1.2 mg/kg/hour)
• Note: maximum licensed dose is 0.6mg/kg/hour
• See table below for quick reference

	40kg	50kg	60kg	70kg	80kg	90kg	100kg	110kg	120kg
Loading dose 0.45mg/kg	18mg	22.5mg	27mg	31.5mg	36mg	40.5mg	45mg	49.5mg	54mg
Maintenance dose	Using undiluted injection solution 500mg in 50ml- rate in ml/hour
4mcg/kg/min (0.24mg/kg/hour)	0.96	1.2	1.4	1.7	1.9	2.2	2.4	2.6	2.9
6.6mcg/kg/min (0.4mg/kg/hour)	1.6	2	2.4	2.8	3.2	3.6	4	4.4	4.8
10mcg/kg/min (0.6mg/kg/hour)	2.4	3	3.6	4.2	4.8	5.4	6	6.6	7.2
20mcg/kg/min (1.2mg/kg/hour) (unlicensed dose once over 0.6mg/kg/hour)	4.8	6	7.2	8.4	9.6	10.8	12	13.2	14.4

Storage

Store in a refrigerator at 2-8⁰C

References

1. Uptodate- accessed online 11 Nov 2021

2. Medusa NHS Injectable medicines acccessed online 11 Nov 2021

Therapeutic classification

Neuromuscular blocking agent