Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- SAFETY: Must be segregated from other drugs in fridge to avoid inadvertent drug selection errors(ref 1)
- Section in fridge must have adequate warning labels
- To be used only in a critical care setting for ventilated patients
- Consideration should be given to dosing obese patients based on Ideal body weight, or an adjusted body weight (ref 2)
- All patients on NMBA infusions should be administered regular lubricating eye care and eyelids should remain closed to protect against corneal injury
(ref 2)
- For Y-site compatibility see below
Available preparations
Atracurium (Tracrium) 25mg in 2.5ml ampoules
Atracurium (Kalceks) 50mg in 5ml ampoules
Reconstitution
Already in solution
Draw up using a 5 micron filter needle
Infusion fluids
Sodium chloride 0.9% or Glucose 5% (if required)
Methods of intravenous administration
Bolus intravenous injection
- Administer by rapid intravenous injection
- Administer over 1 minute or more for patients with significant cardiovascular disease, hypovolaemia or elderly patients
Continuous Intravenous Infusion
- Use undiluted - 500mg in 50ml via a syringe pump
Dose in adults
Mechanically ventilated patients in the ICU, neuromuscular blockade (ref 2)
- Initial bolus of 0.4 to 0.6mg/kg, followed by continuous IV infusion of 4 to 12 mcg/kg/minute
- Usual dose range is 2 to 20 mcg/kg/minute (0.12 to 1.2 mg/kg/hour)
- Note however: maximum licensed dose is 0.6mg/kg/hour
- Titrate every 5 to 10 minutes based upon clinical response and neuromuscular monitoring
- See table below for quick reference
| |
40kg |
50kg |
60kg |
70kg |
80kg |
90kg |
100kg |
110kg |
120kg |
| Loading dose 0.5mg/kg |
20mg |
25mg |
30mg |
35mg |
40mg |
45mg |
50mg |
55mg |
60mg |
| Maintenance dose |
Using undiluted injection solution 500mg in 50ml- rate in ml/hour |
| 4mcg/kg/min (0.24mg/kg/hour) |
0.96 |
1.2 |
1.4 |
1.7 |
1.9 |
2.2 |
2.4 |
2.6 |
2.9 |
| 6.6mcg/kg/min (0.4mg/kg/hour) |
1.6 |
2 |
2.4 |
2.8 |
3.2 |
3.6 |
4 |
4.4 |
4.8 |
| 10mcg/kg/min (0.6mg/kg/hour) |
2.4 |
3 |
3.6 |
4.2 |
4.8 |
5.4 |
6 |
6.6 |
7.2 |
| 20mcg/kg/min (1.2mg/kg/hour) (unlicensed dose once over 0.6mg/kg/hour) |
4.8 |
6 |
7.2 |
8.4 |
9.6 |
10.8 |
12 |
13.2 |
14.4 |
Storage
- Store in a refrigerator at 2-80C
- See Important Information re segregation of storage
References
Tracrium SPC September 2023
Atracurium (Kalceks) SPC September 2022
1:ISMP Targeted Medication Safety Best Practices for Hospitals 2020-2021. Accessed 27/01/2025
2. Uptodate- accessed online 27/01/2025
3. Medusa NHS Injectable medicines acccessed online 27/01/20251
Therapeutic classification
Neuromuscular blocking agent
