Non-Depolarising Neuromuscular Blocking Agent
Pregnancy: Compatible for anaesthetic maintenance — minimal transplacental transfer
Atracurium
Brand names: Tracrium
Adult dose
Dose: Intubation: 0.4–0.5 mg/kg IV. Maintenance: 0.1–0.2 mg/kg supplementary doses. ICU infusion: 5–10 mcg/kg/min.
Route: IV
Frequency: Bolus or continuous infusion
Max: Supplementary doses every 15–25 min
Hofmann elimination — metabolism independent of renal/hepatic function. Produces laudanosine (metabolite) in high doses — may cause seizures in ICU patients with organ failure. Histamine release possible at high doses.
Paediatric dose
Dose: 0.3 mg/kg
Route: IV
Frequency: Supplementary 0.1–0.2 mg/kg every 15–25 min
Max: 0.5 mg/kg
Concentration: 10 mg/mL mg/ml
Neonates and infants: same dose. Cisatracurium preferred in ICU for lower laudanosine production.
Dose adjustments
Renal
No dose adjustment required (Hofmann elimination)
Hepatic
No dose adjustment required (Hofmann elimination)
Paediatric weight-based calculator
Neonates and infants: same dose. Cisatracurium preferred in ICU for lower laudanosine production.
Clinical pearls
- Organ-independent Hofmann elimination: ideal in hepatorenal failure or when reliable metabolism needed
- Preferred over vecuronium in liver disease as less hepatic dependency
- Cisatracurium (stereoisomer) preferred for long-term ICU infusion — less histamine release and less laudanosine
- Store at 2–8°C — do not freeze; decompose at room temperature over time
Contraindications
- Hypersensitivity to atracurium
Side effects
- Histamine release (flushing, bronchospasm, hypotension)
- Laudanosine accumulation (ICU — theoretical seizure risk)
- Anaphylaxis (rare)
- Muscle weakness post-use
Interactions
- Aminoglycosides — prolonged neuromuscular blockade
- Volatile anaesthetics — enhanced blockade
- Suxamethonium — do not mix
- Calcium channel blockers — enhanced blockade
Monitoring
- Train-of-four (TOF) neuromuscular monitoring
- Respiratory function when reversing
- Blood pressure during histamine-releasing doses
Reference: BNFc; BNF; Miller's Anaesthesia; BETTS Study Group. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators