Non-Depolarising Neuromuscular Blocking Agent Pregnancy: Should only be administered to a pregnant woman if the anticipated benefit to the mother outweighs any potential risk to the foetus. Suitable for maintenance of muscle relaxation during Caesarean section as it does not cross the placenta in clinically significant amounts at recommended doses.

Atracurium

Brand names: Tracrium

Atracurium is an intermediate-acting non-depolarising neuromuscular blocking agent used to provide skeletal muscle relaxation during anaesthesia and to facilitate tracheal intubation and mechanical ventilation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.3 to 0.6 mg/kg

Route: Intravenous injection

Frequency: Single bolus (depending on required duration of full block); supplementary doses of 0.1 to 0.2 mg/kg as required to prolong full block

Usual adult dose 0.3-0.6 mg/kg by IV injection, providing relaxation for 15-35 minutes. Endotracheal intubation usually achievable within 90 seconds after 0.5-0.6 mg/kg. Successive supplementary doses do not cause accumulation of neuromuscular blocking effect. By IV infusion: after an initial bolus of 0.3-0.6 mg/kg, continuous infusion at 0.3-0.6 mg/kg/hour during long procedures. ICU: after optional initial bolus 0.3-0.6 mg/kg, maintain block by continuous infusion at 11-13 microgram/kg/min (0.65-0.78 mg/kg/hour); some patients require as low as 4.5 microgram/kg/min or as high as 29.5 microgram/kg/min. Suitable for maintenance of relaxation during Caesarean section (0.3-0.6 mg/kg) as it does not cross the placenta in clinically significant amounts. Elderly: standard dose, but initial dose at lower end of range and administered slowly. Cardiovascular disease: initial dose administered slowly over 60 seconds. Regular monitoring of neuromuscular transmission is necessary.

Paediatric dose

Route: Intravenous injection

Frequency: As per adult regimen

The dosage based on body weight in children over the age of 1 month is the same as in adults (i.e. 0.3-0.6 mg/kg by IV injection). Not recommended in neonates due to insufficient data.

Dose adjustments

Renal

No dose adjustment required in renal or hepatic impairment; standard dose is administered even in the terminal stages of disease.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to atracurium, cisatracurium or to any of the excipients

Side effects

Hypotension (mild, transient) - attributed to histamine release
Skin redness/flushing - attributed to histamine release
Bronchospasm
Anaphylactic and anaphylactoid reactions (very rare), including shock, circulatory failure and cardiac arrest
Urticaria; seizures (in ICU patients); myopathy and muscle weakness (following prolonged administration)

Interactions

Enhanced neuromuscular block with inhalational anaesthetics (enflurane, isoflurane, halothane)
Enhanced block with certain antibiotics, especially aminoglycosides and polymyxins
Enhanced block with lithium, magnesium salts, procainamide and quinidine
Prior succinylcholine quickens onset and may increase depth of block (do not administer until recovered from succinylcholine-induced block)

Clinical monograph

How it works

It competitively antagonises acetylcholine at nicotinic receptors of the neuromuscular junction, preventing depolarisation of the motor end-plate and producing flaccid paralysis.

Prescribing in practice

It must only be administered by, or under the direct supervision of, clinicians experienced in airway management, as it causes complete respiratory paralysis requiring ventilatory support.
It undergoes organ-independent Hofmann elimination and ester hydrolysis, making it useful in renal or hepatic impairment.
Histamine release may occur, occasionally causing flushing, hypotension or bronchospasm, particularly with rapid injection.

Monitoring

Monitor depth of neuromuscular block with a peripheral nerve stimulator and ensure adequate ventilation throughout.

Counselling the patient

Explain to the team that the patient is fully paralysed and depends entirely on assisted ventilation.
Ensure adequate anaesthesia and analgesia are maintained, as the drug has no sedative or analgesic effect.

Evidence & guidelines

Its use reflects established anaesthetic practice; neuromuscular monitoring to confirm recovery is endorsed by professional anaesthetic guidance.

Reference: Miller's Anaesthesia; BETTS Study Group; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs