Parenteral Manual

Atracurium (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Non-depolarizing neuromuscular agent
Original Date: 
August 2005
Revised Date: 
September 2011
  • To facilitate endotracheal intubation   
  • To provide skeletal muscle relaxation during surgery or mechanical ventilation
Reconstitution and Stability: 
  • Available as a 10 mg/mL aqueous solution, pH 3.25-3.65
  • Refrigerate vials 2°C - 8°C.  DO NOT freeze.
  • Vials stable for up to 14 days at room temperature
  • Diluted solutions stable 24 hrs at room temperature or refrigerated
  • Solutions Compatible: D5W, NS
  • Additives/Above Cassette Compatible: KCl (up to 80 mmol/L)
  • Y-site Compatible: dobutamine, dopamine, epinephrine, fentanyl, midazolam, milrinone, morphine
  • Incompatible: alkaline solutions (e.g., sodium bicarbonate, barbiturates), ringer's lactate

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IM NO, tissue irritation
IV Direct YES, critical care areas only
Usual dilution: 10 mg/mL (undiluted)
Infusion time: 1 minute
IV Intermittent Infusion NO
IV Continuous Infusion YES
Usual dilution: 0.2-0.5 mg/mL
  • NB: For patients with increased risk from histamine reaction, the dose should be administered slowly over 1-2 minutes

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Infants/Children(< 2 years):

  • 0.3-0.4 mg/kg IV initially, followed by maintenance doses of 0.3-0.4 mg/kg IV as needed to maintain neuromuscular blockade  OR
  • Continuous infusion: 0.6 - 1.2 mg/kg/hr IV or 10-20 mcg/kg/minute IV

Children > years and Adults:

  • 0.4-0.5 mg/kg IV, then 0.08-0.1 mg/kg IV 20-45 minutes after initial dose to maintain neuromuscular blockade  OR
  • Continuous infusion: 0.4 - 0.8 mg/kg/hr IV or 6.7-13 mcg/kg/min IV (range: 2-15 mcg/kg/min)

Dosage Reductions:

  • Reduce dosage by 33% for patients on isoflurane or enflurane.
  • Reduce dose for patients on succinylcholine or halothane.
  • Reduce dosage by 50% for patients with induced hypothermia (cardio-bypass surgery)
Potential hazards of parenteral administration: 
  • Thought to be relatively free of cardiovascular effects when used in doses <0.5 mg/kg
  • Occasional patients have slight to moderate histamine release which will result in effects such as vasodilation, flushing, occasional rashes, hypotension and bronchospasm
  • The incidence of hypotension is increased in patients with a history of cardiovascular disease
  • Infants have lower incidence of flushing, rash and histamine release
  • Use with caution in patients with a history of cardiovascular disease, asthma, allergies or severe electrolyte disorders; the recommended initial dose is lower than for other patients
  • Atracurium is metabolized in plasma by a nonenzymatic reaction called Hofmann elimination and is minimally dependent upon renal or hepatic function for elimination
  • Onset of action is 2 minutes; peak effect: within 3-5 minutes; duration 20-35 minutes
  • The effects are potentiated by prior administration of any volatile inhalation anesthetic and the dose should be reduced
  • Reversal of neuromuscular blockade can be accomplished by means of neostigmine or edrophonium combined with an anticholinergic agent such as atropine or glycopyrrolate
  • Monitor muscle twitch response to peripheral nerve stimulation, heart rate, blood pressure

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