Atracurium is used for endotracheal intubation, to support mechanical ventilation in intensive care settings, and as a muscle relaxant during general anaesthesia.

Atracurium acts as a non-depolarizing neuromuscular blocking agent by competitively binding to cholinergic (acetylcholine) receptors at the motor end-plate. This prevents acetylcholine from activating the receptor, thereby inhibiting nerve impulse transmission and producing muscle relaxation. The neuromuscular blockade can be reversed by acetylcholinesterase inhibitors such as neostigmine, edrophonium, and pyridostigmine, which increase the availability of acetylcholine at the receptor site.

Adult and Child (>1 month): Initially, 300–600 mcg/kg as bolus IV, with subsequent doses of 100–200 mcg/kg by IV every 15–25 min or 5–10 mcg/kg/min by infusion in prolonged procedures. Higher infusion rate may be used in patients undergoing controlled ventilation in intensive care.

Neuromuscular blocking effects may be increased when used with general anaesthetics (such as enflurane, isoflurane, halothane), certain antibiotics (including aminoglycosides and polymyxins), as well as lithium, magnesium salts, procainamide, and quinidine.

Atracurium is contraindicated in patients with known hypersensitivity to atracurium, cisatracurium, or benzenesulfonic acid. Like other neuromuscular blocking agents, it causes paralysis of respiratory and skeletal muscles but does not affect consciousness.

Common adverse effects include flushing, skin redness, itching, urticaria, wheezing, increased bronchial secretions, bronchospasm, cyanosis, angioedema, and cardiovascular effects such as bradycardia. Injection site reactions such as wheals and redness may also occur. Serious reactions: Anaphylaxis (may be life-threatening).

Common adverse effects include flushing, skin redness, itching, urticaria, wheezing, increased bronchial secretions, bronchospasm, cyanosis, angioedema, and cardiovascular effects such as bradycardia. Injection site reactions such as wheals and redness may also occur. Serious reactions: Anaphylaxis (may be life-threatening).

Use with caution in patients with cardiovascular disease, burns, or asthma. Conditions that may reduce its effect include respiratory alkalosis, hypercalcemia, demyelinating diseases, peripheral neuropathy, denervation, and muscle trauma. Conditions that may enhance its effect include electrolyte imbalance, neuromuscular disorders, metabolic or respiratory acidosis, Eaton-Lambert syndrome, and myasthenia gravis. Use cautiously during pregnancy and lactation.

Overdose may lead to excessive histamine release and cardiovascular effects, especially hypotension.

Non-depolarizing muscle relaxant

Non-depolarizing muscle relaxant