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 a non-depolarising neuromuscular blocking agent used during general anaesthesia to provide muscle relaxation for tracheal intubation and surgery, and to facilitate 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 surgical procedures. 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 muscle depolarisation and contraction.

Prescribing in practice

It provides no sedation or analgesia and causes respiratory paralysis, so it must only be given by those able to maintain a secure airway and ventilation with adequate concurrent anaesthesia.
It undergoes organ-independent Hofmann elimination, making it useful in hepatic or renal impairment, but residual block should be reversed and confirmed before extubation.
Histamine release may cause transient hypotension, flushing, or bronchospasm, particularly with rapid administration.

Monitoring

Monitor depth of neuromuscular blockade with a peripheral nerve stimulator alongside continuous cardiorespiratory monitoring throughout anaesthesia and recovery.

Counselling the patient

This medicine is given by the anaesthetist while you are asleep for your operation.
It relaxes your muscles and a breathing machine supports you during surgery.
Tell your team about any previous reactions to anaesthetic drugs.

Evidence & guidelines

Atracurium is an established neuromuscular blocker with a well-characterised pharmacological profile and predictable organ-independent elimination.

Reference: Tracrium SPC; AAGBI; Miller's Anaesthesia; 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.

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