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atracurium (Tracurium)
Tradename: Tracurium.
Indications:
1) to skeletal muscle relaxation during surgery
2) to increase pulmonary compliance during ventilator-assisted respiration
3) status asthmaticus refractory to other treatment
4) must always be used with a sedative (benzodiazepine)
5) should be used with an analgesic
Dosage:
1) bolus: 0.4-0.5 mg/kg IV.
2) maintenance 2-10 ug/kg/min (0.4-0.8 mg/kg/hr)
Injection: 10 mg/mL (10 mL)
Dosage adjustment in renal failure: not needed
Pharmacokinetics:
1) onset of action is within 2 minutes (IV)
2) maximal effects seen in 3-5 minutes (IV)
3) duration 20-30 min
4) non-enzymatic degradation in blood stream
5) further metabolism by plasma esterases
6) major metabolite laudanosine accumulates with renal failure
7) eliminated in urine & feces
Adverse effects:
1) not common (1-10%)
- flushing, generally mild & due to histamine release
2) uncommon (< 1%)
a) muscle weakness, bradycardia/tachycardia, erythema at site of injection, increased risk of DVT, prolonged paralysis, salivation, potentiation of adverse effects of hyperkalemia or hypokalemia
b) laudanosine accumulation is associated with hypotension, excitation & possibly seizures
Drug interactions:
1) coadministration of aminoglycosides, tetracyclines or clindamycin prolongs & increased neuromuscular blockade
2) coadministration of corticosteroids prolongs muscle weakness
3) K+ depleting agents (thiazides, loop diuretics, amphotericin B, corticosteroids) can increase & prolong neuromuscular paralysis
4) reduce dosage by 33% in patients receiving isoflurane or enflurane
5) reduce by 20% in patients receiving halothane Reversal:
1) neostygmine, pyridostigmine, edrophonium, cholinesterase inhibitors are used with atropine to reverse neuromuscular blockade
2) 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:
1) intermediate-acting, non-depolarizing neuromuscular junction blocker
2) skeletal muscle relaxation produced by diminished response to acetylcholine at the neuromuscular junction
3) block access of acetylcholine to motor end-plate
Interactions
drug interactions
General
aromatic compound
heterocyclic compound, 2 rings
neuromuscular blocker (paralyzing agent)
Properties
MISC-INFO: elimination route PLASMA
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
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