Amikacin
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
Atracurium
Non-depolarising neuromuscular blocker (benzylisoquinolinium) · Skeletal Muscle Relaxant, Anesthesia Adjunct
Also known as Atracurium besilate, Tracrium
START
Intubation 0.4–0.5 mg/kg IV; maintenance bolus 0.1 mg/kg or infusion 5–9 mcg/kg/min
TYPICAL MAX
Titrated to train-of-four monitoring (no fixed ceiling)
STOP IF
Anaphylaxis, severe bronchospasm/hypotension
WATCH
Neuromuscular (train-of-four) monitoring, BP/HR after bolus, ensure ventilation/reversal availability
CDSCO approvedSchedule HATC M03AC04
KDIGO 2024 + manufacturer label
- ONSET
- 3min · onset (~3 min)
- PEAK
- 5min · peak block (~5 min)
- t½
- 20min · plasma t½ (~20 min)
- DURATION
- 30min · clinical block (~30 min)
EXCRETION
Hofmann elimination + ester hydrolysis; non-renal
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Use if required for anaesthesia — does not readily cross placenta in clinically significant amounts
FDA category + note
Top interactionssee all 12 →
- AmikacinSevereDatabaseDDInter
- AminoglycosidesSevereDatabaseKimi deep-research + Cla
- Botulinum Toxin Type ASevereDatabaseDDInter
- Botulinum Toxin Type BSevereDatabaseDDInter
Available in India
33 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Competitive antagonist at the postsynaptic nicotinic acetylcholine receptor of the motor end-plate, producing skeletal muscle relaxation; eliminated organ-independently by Hofmann elimination and ester hydrolysis.
Indications
Skeletal muscle relaxation for tracheal intubation and surgeryFacilitation of mechanical ventilation in ICU
Dosing
- Adult
- Intubation 0.4–0.5 mg/kg IV bolus; maintenance 0.08–0.1 mg/kg every 15–25 min or infusion 5–9 mcg/kg/min.
- Pediatric
- ≥1 month similar weight-based (specialist anaesthesia).
- Renal adjustment
- No adjustment (organ-independent elimination).
- Hepatic adjustment
- No adjustment.
- Geriatric
- No specific adjustment; titrate to monitoring.
- Max dose
- Titrated to neuromuscular monitoring (no fixed ceiling)
Pharmacokinetics
Onset
~2–3 min
Peak effect
~3–5 min
Duration
~20–35 min (intermediate)
Half-life
~20 min
Bioavailability
100% IV
Protein binding
~82%
Metabolism
Hofmann elimination + non-specific ester hydrolysis (→ laudanosine)
Excretion
Renal/biliary (metabolites; laudanosine)
Contraindications
- Known hypersensitivity to atracurium or benzylisoquinolinium agents
- Use only by clinicians skilled in airway management/ventilation
Side effects
Common
Histamine release: flushing, transient hypotension, tachycardiaBronchospasm (mild)Skin wheal at injection
Serious
- Anaphylaxis
- Severe bronchospasm/hypotension (rapid bolus, histamine)
- Prolonged paralysis (ICU, with potentiating drugs)
- Laudanosine accumulation (seizure risk, prolonged ICU/renal failure — theoretical)
Pregnancy & lactation
Pregnancy
Use if required for anaesthesia — does not readily cross placenta in clinically significant amounts
Lactation
Single intraoperative use compatible (not orally bioavailable)
Drug interactions
Aminoglycosides
Severe
Database
Potentiated/prolonged neuromuscular blockade
Reduce dose; monitor train-of-four; have reversal/ventilation
Source: Kimi deep-research + Cla
Botulinum Toxin Type A
Severe
Database
Clinical effect not specified
Source: DDInter
Botulinum Toxin Type B
Severe
Database
Clinical effect not specified
Source: DDInter
Colistimethate
Severe
Database
Clinical effect not specified
Source: DDInter
Gentamicin
Severe
Database
Prolonged paralysis, respiratory failure
Monitor neuromuscular function. May need extended ventilation.
Source: DDInter
Kanamycin
Severe
Database
Clinical effect not specified
Source: DDInter
Magnesium Sulfate
Severe
Database
Marked potentiation of block
Reduce dose; close neuromuscular monitoring
Source: Kimi deep-research + Cla
Neomycin
Severe
Database
Clinical effect not specified
Source: DDInter
Netilmicin
Severe
Database
Clinical effect not specified
Source: DDInter
Paromomycin
Severe
Database
Clinical effect not specified
Source: DDInter
Plazomicin
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
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Ask House about Atracurium
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19