atracurium (Tracurium)
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Introduction
Tradename: Tracurium.
Indications
- to skeletal muscle relaxation during surgery
- to increase pulmonary compliance during ventilator-assisted respiration
- status asthmaticus refractory to other treatment
- must always be used with a sedative (benzodiazepine)
- should be used with an analgesic
Dosage
Dosage adjustment in renal failure
not needed
Pharmacokinetics
- onset of action is within 2 minutes (IV)
- maximal effects seen in 3-5 minutes (IV)
- duration 20-30 min
- non-enzymatic degradation in blood stream
- further metabolism by plasma esterases
- major metabolite laudanosine accumulates with renal failure
- eliminated in urine & feces
elimination via plasma
Adverse effects
- not common (1-10%)
- uncommon (< 1%)
- muscle weakness, bradycardia/tachycardia, erythema at site of injection, increased risk of DVT, prolonged paralysis, salivation, potentiation of adverse effects of hyperkalemia or hypokalemia
- laudanosine accumulation is associated with hypotension, excitation & possibly seizures
Drug interactions
- coadministration of aminoglycosides, tetracyclines or clindamycin prolongs & increased neuromuscular blockade
- coadministration of corticosteroids prolongs muscle weakness
- K+ depleting agents (thiazides, loop diuretics, amphotericin B, corticosteroids) can increase & prolong neuromuscular paralysis
- reduce dosage by 33% in patients receiving isoflurane or enflurane
- reduce by 20% in patients receiving halothane Reversal:
- neostygmine, pyridostigmine, edrophonium, cholinesterase inhibitors are used with atropine to reverse neuromuscular blockade
- neostigmine 1-3 mg slow IV push (0.5 mg in child) with or immediately after atropine 1-1.5 mg IV push
Mechanism of action
- intermediate-acting, non-depolarizing neuromuscular junction blocker
- skeletal muscle relaxation produced by diminished response to acetylcholine at the neuromuscular junction
- block access of acetylcholine to motor end-plate
More general terms
References
- ↑ Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1990, pg 169
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 - not on National VA formulary
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Deprecated Reference