ATRACURIUM 10MG/ML SOLUTION FOR INJECTION OR INFUSION
Active substance(s): ATRACURIUM BESILATE
Atracurium 10 mg/ml
Solution for injection or infusion
Read all of this leaflet carefully before you start receiving
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• If you get any side effects, talk to your doctor or pharmacist. This
includes any possible side effects not listed in this leaflet. See
In this leaflet
1. What Atracurium is and what it is used for
2. What you need to know before you take Atracurium
3. How to take Atracurium
4. Possible side effects
5. How to store Atracurium
6. Contents of the pack and other information
Children and adolescents
The dosage in children over the age of one month is similar to that in
adults on a bodyweight basis.
The use of Atracurium is not recommended in neonates since there
are insufficient data available
Other medicines and Atracurium
Tell your doctor, nurse or pharmacist if you are receiving or have
recently taken any other medicines. This includes medicines obtained
without a prescription, including herbal medicines.
This is because these medicines can affect how well Atracurium
works or can cause side effects.
2. WHAT YOU NEED TO KNOW BEFORE YOU TAKE ATRACURIUM
In particular tell your doctor, nurse or pharmacist if you are receiving
any of the following:
• anaesthetics (used to reduce sensation and pain during surgical
• antibiotics (used to treat infections)
• medicines for heart conditions
• medicines for high blood pressure
• water tablets (diuretics), such as furosemide
• medicines for fits (epilepsy), such as phenytoin or carbamazepine
• medicines containing magnesium, such as those to treat
indigestion and heart burn
• drugs for Alzheimer’s disease (anticholinesterases e.g. donepezil)
• medicines for mental illness, such as lithium
• medicines for inflammation of the joints, such as chloroquine or
Do not take Atracurium if:
• you are allergic to atracurium besilate, any other muscle relaxant or
any of the other ingredients in Atracurium (listed in Section 6)
• you have reacted badly to an anaesthetic before.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant
or are planning to have a baby, ask your doctor for advice before
receiving this medicine.
Do not take Atracurium if any of the above applies to you.
If you are not sure, talk to your doctor, nurse or pharmacist before
you have Atracurium.
Atracurium should only be administered during pregnancy after
careful risk-benefit assessment.
Atracurium can be used during a caesarean section.
Warnings and precautions
Talk to your doctor or pharmacist before receiving Atracurium.
• you have muscle weakness, tiredness or difficulty in co-ordinating
your movements (myasthenia gravis)
• you have a neuromuscular disease, such as a muscle wasting
disease, paralysis, motor neurone disease or cerebral palsy
• you have a burn which requires medical treatment
• you have ever had an allergic reaction to any muscle relaxant which
was given as part of an operation
• you have a history of sensitivity to histamine. In particular, spasm
of the airways may occur if you have a history of allergy or asthma
As precaution restart breast feeding 24 hours after administration of
1. WHAT ATRACURIUM IS AND WHAT IT IS USED FOR
The active substance in Atracurium is atracurium besilate. This
belongs to a group of medicines called muscle relaxants.
Atracurium is used:
• to relax muscles during operations on adults and children over 1
month of age
• to help insert a tube into the windpipe (tracheal intubation), if a
person needs help to breathe
• to relax the muscles of adults in intensive care
Driving and using machines
Do not drive or use machines in exposed situations after anesthesia.
3. HOW TO TAKE ATRACURIUM
How Atracurium is given
Atracurium will be administered to you by a healthcare professional
Atracurium can be given:
• as a single injection into your vein (intravenous bolus injection)
• as a continuous infusion into your vein.
This is where the drug is slowly given to you over a long period of time.
The following information is intended for healthcare professionals only:
Atracurium 10 mg/ml
Solution for injection or Infusion
Atracurium is a highly selective, competitive or non-depolarising
neuromuscular blocking agent. It is used as an adjunct to general
anaesthesia or sedation in the intensive care unit (ICU), to relax
skeletal muscles, and to facilitate tracheal intubation and mechanical
Posology and method of administration
Administration by injection in adults
Route of administration: Intravenous injection or continuous infusion.
The dosage range recommended for adults is 0.3 to 0.6 mg/kg
(depending on the duration of full block required) and will provide
adequate relaxation for about 15 to 35 minutes.
Endotracheal intubation can usually be accomplished within 90
seconds from the intravenous injection of 0.5 to 0.6 mg/kg.
Full block can be prolonged with supplementary doses of 0.1 to
0.2 mg/kg as required. Successive supplementary dosing does not
give rise to accumulation of neuromuscular blocking effect.
Spontaneous recovery from the end of full block occurs in about
35 minutes as measured by the restoration of the tetanic response
to 95% of normal neuromuscular function.
The neuromuscular block produced by Atracurium can be rapidly
reversed by standard doses of anticholinesterase agents, such as
neostigmine and edrophonium, accompanied or preceded by
atropine, with no evidence of recurarisation.
Administration by infusion in adults
After an initial bolus dose of 0.3 to 0.6 mg/kg, Atracurium can be
used to maintain neuromuscular block during long surgical
procedures by administration as a continuous infusion at rates of
0.3 to 0.6mg/kg/hour.
Atracurium can be administered by infusion during cardiopulmonary
bypass surgery at the recommended infusion rates. Induced
hypothermia to a body temperature of 25° to 26°C reduces the rate
of inactivation of atracurium, therefore full neuromuscular block may
be maintained by approximately half the original infusion rate at
these low temperatures.
The dosage in children over the age of one month is similar to that
in adults on a bodyweight basis.
The use of Atracurium is not recommended in neonates since there
are insufficient data available (see section 5.1).
Atracurium may be used at standard dosage in elderly patients. It is
recommended, however, that the initial dose be at the lower end of
the range and that it be administered slowly.
Your doctor will decide the way you are given the drug and the dose
you will receive. It will depend on:
• your body weight
• the amount and duration of muscle relaxation required
• your expected response to the medicine.
Children less than 1 month old should not have this medicine.
If you receive more Atracurium than you should
Atracurium will always be given under carefully controlled conditions.
However, if you think that you have been given more than you should
tell your doctor or nurse immediately.
4. POSSIBLE SIDE EFFECTS
Like all medicines, Atracurium can cause side effects, although not
everybody gets them.
STOP taking Atracurium and contact your doctor if you
• Allergy or hypersensitivity including a lumpy skin rash or ‘hives’
anywhere on your body, swelling of your eyelids, face, lips, mouth
or tongue or wheezing or coughing
• Shock, circulatory failure, cardiac arrest
• Sudden wheeziness, chest pain or chest tightness
Tell your doctor if you experience any of the following effects:
Common (may affect up to 1 in 10 people)
• decrease in blood pressure
• rash or redness of your skin
Very Rare (may affect up to 1 in 10,000 people)
• decrease in heart rate
Not known (frequency cannot be estimated from the available data)
• muscle weakness
If any of the side effects gets serious, or if you notice any side effects
not listed in this leaflet, please tell your doctor, nurse or pharmacist.
If you get any side effects, talk to your doctor, this includes any
possible side effects not listed in this leaflet you can also report side
effects directly via the Yellow Card Scheme,
By reporting side effects you can help provide more information on
the safety of this medicine.
Do not use this medicine if you notice an unclear solution and
extraneous particles or if the container is damaged.
Do not throw away any medicines via wastewater or household
waste. Ask your pharmacist how to throw away medicines you no
longer use. These measures will help protect the environment.
6. FURTHER INFORMATION
What Atracurium contains
• The active substance of Atracurium is atracurium besilate.
• The other ingredients for Atracurium are: benzenesulfonic acid,
water for injections
1 ml solution contains 10 mg of atracurium besilate.
Each 2.5ml ampoule contains 25mg of Atracurium Besilate
Each 5ml ampoule contains 50mg of Atracurium Besilate
What Atracurium looks like and contents of the pack
This medicine is clear and colourless solution
This medicine is supplied in transparent 3 or 5ml glass ampoule,
Each ampoule contains 10 mg/ml of the active ingredient atracurium
Atracurium is packed in carton boxes. Each box can contain 5 or 10
Marketing Authorisation Holder and Manufacturer
Hikma Farmacêutica (Portugal), S.A.
Estrada do Rio da Mó 8, 8A e 8B – Fervença
2705-906 Terrugem SNT, Portugal
Tel.: +351 219608410
Fax: +351 219615102
Consilient Health (UK) Ltd.
No.1 Church Road, Richmond upon Thames,
Surrey. TW9 2QE
This medicinal product is authorised in the Member States of EEA
under the following names:
Do not use Atracurium after the expiry date which is stated on the
label and carton, after EXP. The expiry date refers to the last day of
France: Atracurium Hikma 10 mg/ml Solution injectable/ pour
Ireland: Atracurium 10 mg/ml Solution for injection or infusion
Portugal: Besilato de atracúrio Hikma
Spain: Atracurium Hikma 10 mg/ml Solución inyectable y para
United Kingdom: Atracurium 10 mg/ml Solution for injection or
Keep out of the sight and reach of children.
This leaflet was last approved in May 2016
5. HOW TO STORE ATRACURIUM
Store in a refrigerator 2 and 8°C.
Do not freeze.
Keep the container in the outer carton in order to protect from the
Reduced renal and/or hepatic function
Atracurium may be used at standard dosage at all levels of renal or
hepatic function, including end stage failure.
Shelf life before first opening: 18 months
In patients with clinically significant cardiovascular disease, the initial
dose of Atracurium should be administered over a period of
The solution has to be used immediately after opening the container.
Intensive care unit (ICU)
After an optional initial bolus dose of Atracurium of 0.3 to 0.6 mg/kg,
Atracurium can be used to maintain neuromuscular block by
administering a continuous infusion at rates of between 11 and 13
micrograms/kg/min (0.65 to 0.78 mg/kg/hr). There may be wide
inter-patient variability in dosage requirements and these may
increase or decrease with time. Infusion rates as low as 4.5
microgram/kg/min (0.27 mg/kg/hr) or as high as 29.5 microgram/
kg/min (1.77 mg/kg/hr) are required in some patients.
Special precautions for disposal and other handling
Atracurium is compatible with the following infusion solutions for the
times stated below:
The rate of spontaneous recovery from neuromuscular block after
infusion of Atracurium in ICU patients is independent of the duration
Spontaneous recovery to a train-of-four ratio >0.75 (the ratio of the
height of the fourth to the first twitch in a train-of-four) can be
expected to occur in approximately 60 minutes. A range of 32 to
108 minutes has been observed in clinical trials.
In common with all neuromuscular blocking agents, monitoring
of neuromuscular function is recommended during the use of
Atracurium in order to individualise dosage requirements.
Special precautions for storage
Store between 2 and 8°C. Do not freeze.
Keep the container in the outer carton in order to protect from the light.
Infusion Solution Stability
Sodium Chloride Intravenous Infusion BP (0.9% w/v)
Glucose Intravenous Infusion BP (5% w/v)
Ringer’s Injection USP
Sodium Chloride (0.18% w/v) and Glucose (4% w/v)
Intravenous Infusion BP
Compound Sodium Lactate Intravenous Infusion BP
(Hartmann’s Solution for Injection)
When diluted in these solutions to give Atracurium concentrations of
0.5 mg/ml and above, the resultant solutions will be stable in daylight
for the stated periods at temperatures of up to 30°C.