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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 7.2 8.4  9.6 10.8 12  13.2 14.4

Storage

Store in a refrigerator at 2ºC to 8ºC

References

1. Uptodate- accessed online 11 Nov 2021

2. Medusa NHS Injectable medicines  acccessed online 11 Nov 2021

Therapeutic classification

Neuromuscular blocking agent