Atracurium Intravenous Infusion for Ventilated Adult Patients

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

• SAFETY: Must be segregated from other drugs in fridge to avoid inadvertent drug selection errors^{(ref 1)}
  • Section in fridge must have adequate warning labels
• 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 2)}
• All patients on NMBA infusions should be administered regular lubricating eye care and eyelids should remain closed to protect against corneal injury
  ^{(ref 2)}
• For Y-site compatibility see below

Available preparations

Atracurium (Tracrium) 25mg in 2.5ml ampoules

Atracurium (Kalceks) 50mg in 5ml 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 over 1 minute or more for patients with significant cardiovascular disease, hypovolaemia or elderly patients

Continuous Intravenous Infusion

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

Dose in adults

Mechanically ventilated patients in the ICU, neuromuscular blockade ^{(ref 2)}

• Initial bolus of 0.4 to 0.6mg/kg, followed by continuous IV infusion of 4 to 12 mcg/kg/minute
• Usual dose range is 2 to 20 mcg/kg/minute (0.12 to 1.2 mg/kg/hour)
• Note however: maximum licensed dose is 0.6mg/kg/hour
• Titrate every 5 to 10 minutes based upon clinical response and neuromuscular monitoring
• See table below for quick reference

	40kg	50kg	60kg	70kg	80kg	90kg	100kg	110kg	120kg
Loading dose 0.5mg/kg	20mg	25mg	30mg	35mg	40mg	45mg	50mg	55mg	60mg
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
• See Important Information re segregation of storage

References

Tracrium SPC September 2023

Atracurium (Kalceks) SPC September 2022

1:ISMP Targeted Medication Safety Best Practices for Hospitals 2020-2021. Accessed 27/01/2025

2. Uptodate- accessed online 27/01/2025

3. Medusa NHS Injectable medicines acccessed online 27/01/20251

Therapeutic classification

Neuromuscular blocking agent