Generic Name : Atracurium.

Trade Name    : Tracrium.

Drug Class      : Non-depolarizing neuromuscular blocking agent.

Forms of The Drug

  1. Injectable solution: 10mg/mL.

Mechanism of Action

  1. The mechanism of action of atracurium involves its interaction with nicotinic acetylcholine receptors (nAChRs) found at the neuromuscular junction. Normally, acetylcholine (ACh) is released from nerve endings and binds to nAChRs on the surface of skeletal muscle cells, leading to muscle contraction. However, atracurium competes with acetylcholine for binding to these receptors, but instead of activating them like acetylcholine, it blocks them.
  2. Atracurium acts as a competitive antagonist at the nicotinic receptors, meaning it binds to the receptors without activating them, thereby preventing acetylcholine from binding and exerting its normal stimulatory effect. This blockade of nicotinic receptors prevents the depolarization of the muscle membrane, which is necessary for muscle contraction.

Indications

  1. Surgical Anesthesia.
  2. Mechanical Ventilation.
  3. Facilitation of Procedures: These procedures may include endotracheal intubation, bronchoscopy, cardioversion, and other interventions where muscle relaxation is beneficial for optimal patient management.
  4. Management of Trauma.
  5. Balanced Anesthesia Techniques.

Contraindications

  1. Hypersensitivity
  2. Personal or Family History of Malignant Hyperthermia.
  3. Preexisting Neuromuscular Disorders: Atracurium can exacerbate neuromuscular disorders such as myasthenia gravis, a condition characterized by muscle weakness and fatigue.
  4. Severe Metabolic Acidosis.
  5. Electrolyte Imbalance: Patients with significant electrolyte disturbances, such as hypokalemia or hyperkalemia.
  6. Renal or Hepatic Dysfunction.
  7. Pediatric Patients: While atracurium can be used in pediatric patients, its safety and efficacy in neonates and premature infants have not been well established.

Side Effects

  1. Skin flush (5%).
  2. Erythema (0.6%).
  3. Wheezing (0.2%).
  4. Increased bronchial secretions (0.2%).
  5. Pruritus (0.2%).
  6. Urticaria (0.1%).

Drug Interaction

  1. Antibiotics: Certain antibiotics, particularly aminoglycosides (e.g., gentamicin, amikacin) and polymyxins (e.g., colistin).
  2. Magnesium Sulfate.
  3. Calcium Channel Blockers.
  4. Corticosteroids
  5. Lithium

Precautions

  1. Pregnancy: Category C.
  2. Lactation: While atracurium undergoes metabolism by plasma esterases and is ultimately eliminated through renal and hepatic pathways, the extent to which it is excreted into breast milk remains uncertain. Additionally, there is limited information on the safety profile of atracurium in breastfeeding women and its potential effects on nursing infants.

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