Atracurium Besilate

Atracurium Besilate is a neuromuscular blocking agent, also known as vecuronium besilate, used during general anesthesia to facilitate mechanical ventilation in adults, children, and infants. It is an isomer of atracurium and relaxes skeletal muscles when injected intravenously.

Uses

Atracurium Besilate is used in general anesthesia to relax skeletal muscles, allowing the performance of medical procedures such as laryngeal intubation. In patients with neuromuscular diseases, such as myasthenia gravis, it may also be used to assist in controlling muscular spasms. It can also be used to reduce airway resistance in asthmatic patients.

Brand Name	Atracurium Besilate
Type
Weight
Generic	Atracurium Besilate
Manufacturer
Available in	English বাংলা

Mechanism of Action

Atracurium Besilate is a competitive inhibitor of the acetylcholine-binding sites at the post-junctional neuromuscular endplate. This action is antagonized by acetylcholinesterase and acetylcholine, which can reverse the effects of the drug.

How Long Does It Take to Work?

Atracurium Besilate begins to take effect within 5–10 minutes and has an onset of action of approximately 30–60 minutes. Its effects last for about 2 hours if an intravenous route is used. With an intramuscular route, its effects can last up to 6 hours.

Absorption

Atracurium Besilate is virtually insoluble in water and so it is only administered intravenously or intramuscularly. It is rapidly absorbed from the injection site and distributed throughout the body.

Route of Elimination

The majority of Atracurium Besilate is eliminated unchanged through renal excretion or metabolized by isomerization or hydrolysis. Approximately 10-15% of the drug is eliminated via the hepatic metabolism.

Dosage

Adult and Child (>1 month): Initially, 300-600 mcg/kg as bolus IV, with subsequent doses of 100-200 mcg/kg by IV every 15-25 min or 5-10 mcg/kg/min by infusion in prolonged procedures. Higher infusion rate may be used in patients undergoing controlled ventilation in intensive care.

The recommended dosage of Atracurium Besilate is 0.5-2 mg/kg body weight. In adults, the usual intravenous dose is 0.5-1 mg/kg. The dose in children is 0.75-1 mg/kg. The intramuscular dose is 0.2-0.75 mg/kg body weight. It is not recommended for use in children below 8 months of age.

Administration

Atracurium Besilate is administered intravenously or intramuscularly. While intravenous administration is more commonly used, intramuscular administration can also be used in emergency situations. The drug should not be administered through bolus injection or as an intrathecal injection. It should also not be administered in combination with anticholinergic drugs as this can cause a synergistic effect.

Side Effect

Common side effects of Atracurium Besilate include headaches, nausea, and dizziness. It can also cause a decrease in blood pressure and heart rate, an increase in respiration, and muscle weakness. Rare side effects can include allergic reactions (such as hives, rash, and itching), cardiovascular collapse, and anaphylactic shock.

Toxicity

Atracurium Besilate is generally safe and well-tolerated, but an overdose can be fatal. High doses of the drug can cause cardiovascular depression, respiratory failure, and compensatory tachycardia. Treatment of an overdose should include the use of resuscitation measures and the administration of atropine or a cholinesterase inhibitor.

Precautions

Atracurium Besilate should not be used in patients with known hypersensitivity to the drug. Care should be taken when administering the drug to patients with myasthenia gravis as the drug can cause airway obstruction or extreme respiratory depression. The drug should also be used with caution in patients with renal or hepatic impairment due to its long elimination half-life.

Interactions

Atracurium Besilate interacts with a variety of drugs and can cause CNS depression and respiratory depression when combined with other drugs such as barbiturates, narcotics, and sedatives. The drug can also interfere with the elimination of other drugs due to its long elimination half-life, and can also interact with neuromuscular blocking agents, anticholinergic drugs, and anticonvulsants.

Disease Interactions

Atracurium Besilate shouldn't be used in patients with renal or hepatic impairment, or in patients with myasthenia gravis. The drug can also be dangerous for patients with a history of cardiovascular or respiratory disease as it can cause respiratory depression.

Drug Interactions

Atracurium Besilate can interact with a variety of drugs such as barbiturates, narcotics, sedatives, and neuromuscular blocking agents. It can also interact with anticonvulsants, anticholinergics, and medications for the treatment of glaucoma. Care should be taken when administering the drug to patients on these medications.

Food Interactions

Atracurium Besilate may interact with certain foods, such as alcohol. Alcohol consumption is not recommended when taking the drug due to the risk of increased side effects.

Pregnancy Use

Atracurium Besilate has not been adequately studied in pregnant women and should be used with caution in these patients. It should also be used with caution in women who are breastfeeding.

Lactation Use

Atracurium Besilate has not been adequately studied in breastfeeding women and should be used with caution in this population. It may be necessary to stop breastfeeding while taking the drug.

Acute Overdose

An overdose of Atracurium Besilate can be fatal. Treatment of an overdose includes the use of resuscitation measures and the administration of atropine or a cholinesterase inhibitor. Hemodialysis may also be necessary in severe cases.

Contraindication

Atracurium Besilate should not be used in patients with known hypersensitivity to the drug or to any of its components. It should also not be used in patients with myasthenia gravis or any history of cardiovascular or respiratory disease.

Use Direction

Atracurium Besilate should always be prepared and administered by a qualified healthcare provider. It should only be given intravenously or intramuscularly. Care should be taken to avoid any inadvertent intraarticular or intrathecal administration.

Storage Conditions

Atracurium Besilate should be stored in its original container at room temperature and away from heat and direct sunlight. The drug should also be kept away from children to avoid accidental ingestion.

Volume of Distribution

The volume of distribution of Atracurium Besilate is approximately 5.3 L/kg. It is widely distributed throughout the body.

Half-Life

Atracurium Besilate has a half-life of 10-25 minutes in adults and 13-35 minutes in infants and children. In patients with renal or hepatic impairment, its half-life is increased.

Clearance

The clearance of Atracurium Besilate is 0.17-0.42 L/kg/min in adults and 0.13-0.4 L/kg/min in infants and children. Its clearance is reduced in patients with renal or hepatic impairment.

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