Atracurium Besilate: Brands, Price & Uses in Bangladesh

Atracurium Besilate is a non-depolarizing (curariform) skeletal muscle relaxant. Its established, evidence-based uses include:

• Adjunct to general anesthesia (FDA-approved/established use) — to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgical procedures.
• Facilitation of mechanical ventilation (established use) — to induce and maintain skeletal muscle paralysis in intubated, mechanically ventilated patients in intensive care unit (ICU) settings.

Atracurium Besilate has no analgesic, sedative, or amnesic properties and must always be used together with adequate anesthesia, sedation, and/or analgesia, as it does not alter consciousness or the perception of pain on its own.

Atracurium Besilate must be administered only by, or under the direct personal supervision of, anesthesiologists or other clinicians thoroughly familiar with the use of neuromuscular blocking agents and airway management, in a setting with immediate access to equipment for endotracheal intubation and mechanical ventilation, and with facilities for artificial respiration.

Adult dosing

Pediatric dosing

In children 1 month to 2 years of age and 2–17 years of age, initial doses similar to those used in adults (approximately 0.3–0.4 mg/kg) have been used under general anesthesia, with maintenance and infusion doses adjusted according to clinical response; use in neonates and infants requires particular caution and close monitoring.

Renal/hepatic impairment

No dosage adjustment is generally required in renal or hepatic impairment because elimination is largely organ-independent (Hofmann elimination/ester hydrolysis); however, careful individualized titration and monitoring are still recommended.

Dosing must always be individualized and guided by peripheral nerve stimulator (train-of-four) monitoring whenever possible, along with clinical assessment of neuromuscular function.

The most common adverse effects associated with Atracurium Besilate relate to dose-related histamine release and include:

• Transient flushing or skin rash
• Hypotension (usually mild and transient)
• Tachycardia or, less commonly, bradycardia
• Bronchospasm/wheezing, particularly in patients with reactive airway disease

Rare but serious effects include severe anaphylactic or anaphylactoid reactions (with hypotension, bronchospasm, and/or airway edema), and prolonged neuromuscular blockade with resulting prolonged apnea/respiratory insufficiency, especially if underlying risk factors (see Precautions and Warnings) are present.