Drug Interaction:
Interacting drugs - summary
+ Atracurium
Thiazide Diuretics
The neuromuscular blocking effects of atrcurium increased by thiazide
diuretics. Hypokalemia enhances the neuromuscular blockade,
General Anesthetics eg. Enflurane/ Isoflurane/ alothane/Aminoglycosides/Lithium / Verapramil /Trimethaphan/Procaonamide/Quinidine
These medications enhance the neuromuscular blocking action of atrcurium.
Magnesium Sulfate
When administered for the management of toxemia of pregnancy, enhance
neuromuscular blockade of pancuronium.
Other muscle relaxants
If administerd during the same procedure, consider the possibility of a synergistic or
antagonist effect.
Phenytoin /Theophylline
Phenytoin and theophylline cause resistence to, or reversal of, the
neuromuscular blocking action of atracurium
Sucinylcholine
Succinylcholine does not enhance duration but quickens onset and increase
depth of atracurium induced neuromuscular blockade
Acetylcholine esterase inhibitors eg. Neostigmine /Edrophonium, /Pyridostigmine
Antagonism is inhibited and neuromuscular block is reversed by acetylcholineesterase inhibitors.
Corticosteroids
Prolonged weakness occur
Indication:
Adjunct to general anesthesia.
Adverse Reaction:
Hypersensitivity- Allergic reactions(anaphylactic or anaphylactoid responses) rarely severe
Dermatologic- Rash, urticaria reactionat injection site
Musculoskeletal- Inadequate block, prolonged block
Cardiovascular- Hypotension, vasodilation(flushing) tachycardia, bradycardia,
Respiratory- Dyspnea, bronchospasm, laryngospasm
Contra-Indications:
Hypersens.
Special precautions:
Neonates, severe CVS disorders, renal/hepatic dysfunction, myasthenia gravis and other neuromuscular disorders, severe electrolyte imbalance.
Concomittant therapy- Because potent inhalation agents or prior administration of succinylcholine enhance the intensity and duration of blockade of pancuronium, consider these factors when determing initial and incremental dosage.
Histamine release- excercise caution especially when substantial hisatamine release would be hazardous ( eg. patients clinically significant cardiovascular disease, severe anaphylactoid reactions or asthma)
Benzyl alcohol- this preoduct contains benzyl alcohol which has been associated with a fatal- gasping syndrome- in premature infants.
Bradycardia- during anesthesia may be most common with atracurium than other muscle relaxants because atrcurium has no clinically significant effects on heart rate. it will not counteract bradycardia or vaginal stimulation.
Usuage in neuromuscular diseases- in which potentaition of nondepolarizing agents has been noted .(eg myasthnia gravis, Eaton -Lmabert syndrome)
Malignnant hyperthermia- (MH) - halogenated anesthetic agents and succinyl choline are recongnized as prinicipal pharmocological agents i MH susceptible patients
Long-term use- when atrcurium is used in the ICU it is recommeneded that neuromuscular transmission be monitored continously during administrtion with the help of nerve stimulator.
Warnings
Anesthesia- atrcurium has no known effect on consciouness ,pain threshold or cerebration. Use only with anesthesia.
Elderly- nodifferences have been identified in effectiveness, safety or dosage requirements
Pregnancy- use during pregnancy onlyif potentail benefits outweigh the potentail hazards to the fetus.
Lactation- safey for usein the nursing mother is not established.
Children- safety and efficacy for children < 1 month old are not established
Dosages/ Overdosage Etc:
Indications:
Adjunct to general anesthesia.
Dosage:
Administer IV/ IM . Use may cause tissue irritation. Initial adult dose- 0.4 to 0.5mg/kg bolus injection.
Overdosage-
Symptoms -
Extended skeletal muscle weakness, decreased respiratory reserve, lower tidal volume, prolonged apnea, cardiovascular collapse and sudden release of histamine. sufficiently excessive doses of nondepolarizing muscle relaxants have no antidote.
Treatment
1. A peripheral nerve stimulator may be used to assesss the degree of residual neuromuscular blockade .
2. For residual neuromuscular blockade with respiratory paralysis or inadequate ventilation, maintain airway and administer manual or mechanical ventilation.
Missed dose
1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosin schedule.
3. Do not double doses.
Pharmacology/ Pharmacokinetics:
Pharmacology
Atrcurium a nondepolarizing skeletal muscle relaxant antagonizes the neurotransmitter action by binding competitively with cholinergic receptor sites on the motor end-plate.
Pharmacokinetics
The elimination half-lfe is about 20 minutes. Atrcurium is inactivated in plasma via two nonoxidative pathways .Some placenta transfer occurs.
Pregnancy and lactation:
Pregnancy
Use during pregnancy onlyif potentail benefits outweigh the potentail hazards to the fetus.
Lactation
Safey for use in the nursing mother is not established.
Children- Safety and efficacy for children < 1 month old are not established
Manufacturer Details