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
