Atracurium: Pediatric drug information

For additional information see "Atracurium: Drug information" and "Atracurium: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Therapeutic Category

Neuromuscular Blocker Agent, Nondepolarizing;
Skeletal Muscle Relaxant, Paralytic

Dosing: Neonatal

Note: Ensure adequate pain control and sedation prior to and during administration of neuromuscular blockade. Dose to effect; doses must be individualized due to interpatient variability.

Neuromuscular blockade

Neuromuscular blockade: Very limited data available:

Intermittent IV: Usual dose: 0.25 to 0.4 mg/kg/dose (Ref); may repeat dose every 20 to 30 minutes as needed (Ref). Note: Some premature neonates receiving higher doses (0.5 mg/kg) experienced toxicity and fatal outcomes; however, association with atracurium could not be confirmed. Due to potential for adverse effects, lower doses are recommended (Ref).

Continuous IV infusion: Initial: 6.7 mcg/kg/minute (0.4 mg/kg/hour), titrate until desired neuromuscular blockade is achieved; some investigators have suggested adjusting the infusion rate every 20 to 30 minutes (Ref).

Dosing: Pediatric

Note: Ensure adequate pain control and sedation prior to and during administration of neuromuscular blockade. Dose to effect; doses must be individualized due to interpatient variability. Maintenance doses in infants and children may need to be administered with slightly greater frequency compared to adults. Dosing in obese patients should be calculated using ideal body weight (Ref):

Neuromuscular blockade

Neuromuscular blockade:

ICU paralysis (eg, facilitate mechanical ventilation) (Ref):

Infants, Children, and Adolescents:

Initial bolus: IV: 0.3 to 0.6 mg/kg/dose; repeat additional doses as needed to maintain desired neuromuscular blockade or begin continuous infusion.

Continuous IV infusion: Initial: 5 to 12 mcg/kg/minute (0.3 to 0.7 mg/kg/hour); range: 5 to 40 mcg/kg/minute (0.3 to 2.4 mg/kg/hour).

Adjunct to surgical anesthesia:

Bolus doses:

Infants and Children <2 years: Initial: IV: 0.3 to 0.4 mg/kg once, followed by additional doses as needed to maintain neuromuscular blockade.

Children ≥2 years and Adolescents: IV: 0.4 to 0.5 mg/kg once as initial dose, then administer 0.08 to 0.1 mg/kg/dose 20 to 45 minutes after the initial dose to maintain neuromuscular blockade; repeat dose every 15 to 25 minutes as needed. Note: Initial dose should be reduced to 0.3 to 0.4 mg/kg in patients with significant cardiovascular disease or with history of increased risk of histamine release (eg, asthma, severe anaphylactoid reaction).

Continuous IV infusion in operating room during extended surgical procedures:

Infants and Children <2 years: Continuous IV infusion: Initial: 6 to 14 mcg/kg/minute (0.4 to 0.8 mg/kg/hour) initiated at the first signs of recovery from initial bolus; titrate until desired neuromuscular blockade is achieved (Ref).

Children ≥2 years and Adolescents: Continuous IV infusion: Initial: 9 to 10 mcg/kg/minute (0.5 to 0.6 mg/kg/hour), initiate infusion at initial signs of recovery from bolus dose, titrate until desired neuromuscular blockade is achieved; block is usually maintained by a rate of 5 to 9 mcg/kg/minute (0.3 to 0.5 mg/kg/hour); range: 2 to 15 mcg/kg/minute (0.1 to 0.9 mg/kg/hour).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: No dosage adjustment necessary.

Dosing: Liver Impairment: Pediatric

Infants, Children, and Adolescents: No dosage adjustment necessary.

Dosing: Adult

(For additional information see "Atracurium: Drug information")

Note: Doses must be individualized due to interpatient variability, patient specific factors, and/or comorbidities (eg, severe trauma, burn injury) (Ref).

Endotracheal intubation

Endotracheal intubation: Note: Ensure adequate pain control and sedation prior to and during administration of neuromuscular blockade.

IV: 0.5 to 0.6 mg/kg once (Ref).

Mechanically ventilated patients in the ICU, neuromuscular blockade

Mechanically ventilated patients in the ICU, neuromuscular blockade:

Note: Ensure adequate pain control and sedation prior to and during administration of neuromuscular blockade. May use to facilitate mechanical ventilation (eg, refractory moderate to severe acute respiratory distress syndrome; refractory, life-threatening status asthmaticus; or shivering from therapeutic hypothermia) (Ref). Refer to institutional protocols. Titration specifics may vary; a titration example is provided below.

Continuous infusion : IV: 0.4 to 0.6 mg/kg initial loading dose, followed by continuous infusion of 4 to 12 mcg/kg/minute; titrate every ~5 to 10 minutes based on clinical response and neuromuscular monitoring (eg, train-of-four); usual dosage range: 2 to 20 mcg/kg/minute (Ref).

Intermittent dose : IV: 0.4 to 0.6 mg/kg, followed by 0.08 to 0.1 mg/kg every ~15 to 25 minutes based on clinical response and neuromuscular monitoring (eg, train-of-four) (Ref).

Neuromuscular blockade during general anesthesia

Neuromuscular blockade during general anesthesia (adjunctive therapy):

Maintenance dosing: Note: Inhaled anesthetic agents (eg, desflurane, isoflurane, sevoflurane) prolong the duration of action of atracurium and may potentiate the neuromuscular blockade.

Continuous infusion : IV: 4 to 12 mcg/kg/minute as an initial continuous infusion; titrate as needed based on clinical response and neuromuscular monitoring (eg, train-of-four); usual dosage range: 2 to 15 mcg/kg/minute (Ref).

Intermittent dose : IV: 0.08 to 0.1 mg/kg every ~15 to 25-minute intervals as needed based on clinical response and neuromuscular monitoring (eg, train-of-four) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

Dosing: Liver Impairment: Adult

No dosage adjustment necessary.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined. Adverse reactions are mild, rare, and generally suggestive of histamine release.

1% to 10%: Cardiovascular: Flushing

<1%, postmarketing, and/or case reports: Bradycardia, bronchospasm, dyspnea, erythema, hypersensitivity reaction, hypotension, increased bronchial secretions, injection site reaction, laryngospasm, pruritus, seizure, tachycardia, urticaria, wheezing

Contraindications

Hypersensitivity to atracurium or any component of the formulation; known hypersensitivity to benzyl alcohol (multiple dose vials)

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: Severe anaphylactic reactions have been reported with atracurium use; some life-threatening and fatal. Appropriate emergency treatment (including epinephrine 1 mg/mL) should be immediately available during use. Use caution in patients with previous anaphylactic reactions to other neuromuscular blocking agents.

• Bradycardia: May be more common with atracurium than with other neuromuscular-blocking agents since it has no clinically significant effects on heart rate to counteract the bradycardia produced by anesthetics.

• Prolonged paralysis: Some patients may experience prolonged recovery of neuromuscular function after administration (especially after prolonged use). Patients should be adequately recovered prior to extubation. Other factors associated with prolonged recovery should be considered (eg, corticosteroid use, patient condition).

Disease-related concerns:

• Burn injury: Resistance may occur in burn patients (≥20% of total body surface area), usually several days after the injury, and may persist for several months after wound healing (Han 2009).

• Conditions that may antagonize neuromuscular blockade (decreased paralysis): Respiratory alkalosis, hypercalcemia, demyelinating lesions, peripheral neuropathies, denervation, and muscle trauma may result in antagonism of neuromuscular blockade (ACCM/SCCM/ASHP [Murray 2002]; Greenberg 2013; Gropper 2019; Naguib 2002).

• Conditions that may potentiate neuromuscular blockade (increased paralysis): Electrolyte abnormalities (eg, severe hypocalcemia, severe hypokalemia, hypermagnesemia), neuromuscular diseases, metabolic acidosis, respiratory acidosis, Eaton-Lambert syndrome and myasthenia gravis may result in potentiation of neuromuscular blockade (Greenberg 2013; Gropper 2019; Naguib 2002).

Special populations:

• Older adults: Use with caution in older adults; effects and duration are more variable.

• Immobilized patients: Resistance may occur in patients who are immobilized.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

Other warnings/precautions:

• Appropriate use: Maintenance of an adequate airway and respiratory support is critical. Resistance may develop with chronic treatment. All patients should receive eye care including liberal use of lubricating drops, gel, or ointment, and eyelids should remain closed during continuous neuromuscular blockade to protect against damage to the cornea (ulceration and drying).

• Experienced personnel: Should be administered by adequately trained individuals familiar with its use.

• Histamine release: Reduce initial dosage and inject slowly (over 1 to 2 minutes) in patients in whom substantial histamine release would be potentially hazardous (eg, patients with clinically-important cardiovascular disease).

• Risk of medication errors: Accidental administration may be fatal. Confirm proper selection of intended product, store vial so the cap and ferrule are intact and the possibility of selecting the wrong product is minimized, and ensure that the intended dose is clearly labeled and communicated, when applicable.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as besylate:

Generic: 100 mg/10 mL (10 mL)

Solution, Intravenous, as besylate [preservative free]:

Generic: 50 mg/5 mL (5 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Atracurium Besylate Intravenous)

50 mg/5 mL (per mL): $1.14 - $1.90

100 mg/10 mL (per mL): $1.13 - $1.90

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Pediatric

Parenteral: For IV use only; do not administer IM due to tissue irritation.

IV bolus: Administer undiluted as IV bolus injection.

Continuous IV infusions: Further dilute in a compatible fluid and administer via an infusion pump.

Administration: Adult

IV: Administer undiluted as a bolus injection; do not administer IM (excessive tissue irritation). Continuous infusion administration requires the use of an infusion pump. Do not administer with alkaline solutions in the same syringe or simultaneously in the same IV line. Use infusion solutions within 24 hours of preparation.

Storage/Stability

Store intact vials at 2°C to 8°C (36°F to 46°F). Do not freeze. Upon removal from refrigeration to room temperature storage conditions (25°C/77°F), use within 14 days even if re-refrigerated. Dilutions of 0.2 mg/mL or 0.5 mg/mL in 0.9% sodium chloride, dextrose 5% in water, or 5% dextrose in sodium chloride 0.9% are stable for up to 24 hours at room temperature or under refrigeration.

According to the 2020 to 2021 ISMP Targeted Medication Safety Best Practices for Hospitals, neuromuscular blockers should be segregated, sequestered, and differentiated from all other medication wherever they are stored.

Use

Adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation (FDA approved in ages ≥1 month and adults).

Medication Safety Issues

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (neuromuscular blocker agent) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).

Other safety concerns:

Only storing in places within the hospital that they are routinely used.

Placing in sealed boxes or in rapid sequence intubation kits (preferred).

Limiting availability in automated dispensing cabinets to perioperative, labor and delivery, critical care, and emergency departments only.

Placing in separate lidded containers within the pharmacy refrigerator or other isolated pharmacy storage area.

Affixing an auxiliary label to clearly communicate respiratory paralysis will occur and ventilation required on all storage bins and/or automated dispensing pockets/drawers (exception anesthesia-prepared syringes) stating one of the following:

Warning: Causes Respiratory Arrest – Patient Must Be Ventilated

Warning: Paralyzing Agent – Causes Respiratory Arrest

Warning: Causes Respiratory Paralysis – Patient Must Be Ventilated

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acetylcholinesterase Inhibitors: May decrease neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Aminoglycosides: May increase therapeutic effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Bacitracin (Systemic): May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Botulinum Toxin-Containing Products: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Bromperidol: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Calcium Channel Blockers: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Capreomycin: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

CarBAMazepine: May decrease serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Cardiac Glycosides: Neuromuscular-Blocking Agents may increase arrhythmogenic effects of Cardiac Glycosides. Risk C: Monitor

Clindamycin (Topical): May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Colistimethate: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of these products. Monitor for deeper, prolonged neuromuscular-blocking effects (respiratory paralysis) in patients receiving concomitant neuromuscular-blocking agents and colistimethate. Risk D: Consider Therapy Modification

Corticosteroids (Systemic): Neuromuscular-Blocking Agents (Nondepolarizing) may increase adverse neuromuscular effects of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Management: If concomitant therapy is required, use the lowest dose for the shortest duration to limit the risk of myopathy or neuropathy. Monitor for new onset or worsening muscle weakness, reduction or loss of deep tendon reflexes, and peripheral sensory decriments Risk D: Consider Therapy Modification

CycloSPORINE (Systemic): May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Esketamine (Injection): May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Fosphenytoin-Phenytoin: May decrease neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, this effect is observed with chronic phenytoin administration. Fosphenytoin-Phenytoin may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, this effects is observed with acute/short term phenytoin administration. Risk C: Monitor

Gepotidacin: May decrease therapeutic effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Inhalational Anesthetics: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Management: When initiating a non-depolarizing neuromuscular blocking agent (NMBA) in a patient receiving an inhalational anesthetic, initial NMBA doses should be reduced 15% to 25% and doses of continuous infusions should be reduced 30% to 60%. Risk D: Consider Therapy Modification

Ketamine: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Ketorolac (Nasal): May increase adverse/toxic effects of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Risk C: Monitor

Ketorolac (Systemic): May increase adverse/toxic effects of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Risk C: Monitor

Lincosamide Antibiotics: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Lithium: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Local Anesthetics: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Loop Diuretics: May decrease neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Loop Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Magnesium Salts: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Minocycline (Systemic): May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Pancuronium: May increase adverse/toxic effects of Neuromuscular-Blocking Agents. Pancuronium may increase therapeutic effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Pholcodine: May increase adverse/toxic effects of Neuromuscular-Blocking Agents. Specifically, anaphylaxis has been reported. Risk C: Monitor

Polymyxin B: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Procainamide: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

QuiNIDine: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

QuiNINE: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk X: Avoid

Tetracyclines: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Thiazide and Thiazide-Like Diuretics: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Trimebutine: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Vancomycin: May increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Pregnancy Considerations

Small amounts of atracurium have been shown to cross the placenta when given to women during cesarean section.

Monitoring Parameters

Muscle twitch response to peripheral nerve stimulation, heart rate, blood pressure, assisted ventilation status.

Mechanism of Action

Blocks neural transmission at the myoneural junction by binding with cholinergic receptor sites

Pharmacokinetics (Adult Data Unless Noted)

Onset of action (dose dependent): 2 to 3 minutes; Peak effect: 3 to 5 minutes.

Duration: Recovery begins in 20 to 35 minutes following initial dose of 0.4 to 0.5 mg/kg under balanced anesthesia; recovery to 95% of control takes 60 to 70 minutes; hypothermia may prolong the duration of action.

Distribution (Fisher 1990): V_d:

Infants: 0.21 ± 0.12 L/kg.

Children: 0.13 ± 0.04 L/kg.

Adults: 0.1 ± 0.02 L/kg.

Metabolism: Undergoes ester hydrolysis and Hofmann elimination (nonbiologic process independent of kidney, hepatic, or enzymatic function); metabolites have no neuromuscular blocking properties; laudanosine, a product of Hofmann elimination, is a CNS stimulant and can accumulate with prolonged use. Laudanosine is hepatically metabolized.

Half-life elimination:

Infants: 20 ± 5.1 minutes (Fisher 1990).

Children: 17.2 ± 5.1 minutes (Fisher 1990).

Adults: Biphasic: Initial (distribution): 2 minutes; Terminal: 20 minutes.

Excretion: Urine (<5%).

Clearance (Fisher 1990):

Infants: 7.9 ± 0.2 mL/kg/minute.

Children: 6.8 ± 1.6 mL/kg/minute.

Adults: 5.3 ± 0.9 mL/kg/minute.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AR) Argentina: Atracurio gray | Atracurium fabra | Atracurium gemepe | Atracurium northia | Atracurium pharmavial | Gelolagar | Tracurix | Tracuron;
(AT) Austria: Atracurium hameln | Atracuriumbes deltaselect | Tracrium;
(AU) Australia: Atracurium;
(BD) Bangladesh: Atrelax | Tracrium;
(BE) Belgium: Atracurium kalceks | Tracrium;
(BG) Bulgaria: Atracurium kalceks;
(BR) Brazil: Besilato de atracurio | Besilato de atracurio basi | Tracrium | Tracur;
(CH) Switzerland: Atracurium Labatec | Tracrium;
(CN) China: Atracurium;
(CO) Colombia: Tracrium;
(CZ) Czech Republic: Atracurium kalceks;
(DE) Germany: Atracurium | Atracurium Actavis | Atracurium hikma | Tracrium;
(DO) Dominican Republic: Atracurio libra | Tracur;
(EC) Ecuador: Atracur | Besilato de atracurio | Tracrium;
(EE) Estonia: Atracurium | Atrasyl | Tracrium;
(EG) Egypt: Atrabesylate | Atracurium | Faulcurium | Tracrium | Trathesia;
(ES) Spain: Atracurio inibsa | Atracurio rovi | Besilato de atracurio hameln | Besilato de Atracurio Inibsa | Tracrium;
(FI) Finland: Atracurium alpharm | Tracium | Tracrium;
(FR) France: Atracurium hikma | Tracrium;
(GB) United Kingdom: Atracurium | Tracrium;
(GR) Greece: Tracrium;
(HU) Hungary: Atracurium besilate kalceks | Tracrium;
(ID) Indonesia: Atracurium | Atracurium besylat | Farelax | Notrixum | Tracrium;
(IE) Ireland: Atracurium | Tracrium;
(IL) Israel: Tracrium;
(IN) India: Acris | Arium | Artacil | Atacurium | Atcuron | Atraaish k | Atracade | Atrager | Crimat | Kabitran | Tracrium | Troycurium;
(IT) Italy: Acurmil | Tracrium;
(JO) Jordan: Atacure | Retalex | Tracrium;
(KE) Kenya: Acuron | Artacil | Atracurium | Atracurium besylate;
(KR) Korea, Republic of: Acrium | Aculex | Atra | Tracrium;
(KW) Kuwait: Tracrium;
(LB) Lebanon: Tracrium;
(LT) Lithuania: Atracurium hikma | Tracrium;
(LU) Luxembourg: Tracrium;
(LV) Latvia: Atracurium | Atracurium besilate kalceks | Tracrium;
(MA) Morocco: Tracrium;
(MX) Mexico: Atracurio | Atracurio Senosiain | Relatrac | Tracrium;
(MY) Malaysia: Atracurium | Atracurium hameln | Atracurium kalceks | Atralex | Notrixum;
(NL) Netherlands: Atracurium | Atracuriumdibesilaat | Tracrium;
(NO) Norway: Atracurium | Tracrium | Tracrium aspen;
(NZ) New Zealand: Atracurium besylat;
(PE) Peru: Atracurio;
(PH) Philippines: Atracor | Atracurium besylate | Atracurium Hospira | Atravell | Atrium | Tracrium;
(PK) Pakistan: Acuron | Atrelax | Efacurim | Relaxtron | Tracrium | Tracur;
(PL) Poland: Tracrium;
(PR) Puerto Rico: Atracurium besylate | Tracrium;
(PT) Portugal: Besilato de atracurio basi | Besilato de atracurio hikma | Besilato de atracurio queenlabs | Faulcurium | Tracrium;
(PY) Paraguay: Arium | Atracurio libra | Atracurium northia | Tracur | Tracurix;
(QA) Qatar: Atacure | Neucurium | Tracrium;
(RO) Romania: Atracurium kalceks;
(RU) Russian Federation: Atracuria besylate | Atracurium belmed | Atracurium besilat | Atracurium medargo | Atracurium novo | Notrixum | Ridelat c | Tracrium;
(SA) Saudi Arabia: Atacure | Atracurium besylate;
(SE) Sweden: Tracrium;
(SG) Singapore: Atracurium | Atracurium hameln;
(SI) Slovenia: Atracurium besilate kalceks | Tracrium;
(SK) Slovakia: Atracurium kalceks;
(TH) Thailand: Notrixum;
(TN) Tunisia: Atracurium;
(TR) Turkey: Atracurium | Atrasyl | Dematrac | Neucurium;
(TW) Taiwan: Atracurium | Atracurium besylat | Atracurium besylate | Genso | Tracrium;
(UA) Ukraine: Intuban;
(UG) Uganda: Acuron | Retalex;
(UY) Uruguay: Atracur | Atracurio | Atracurium | Tracrium | Tracur | Tracurix;
(VE) Venezuela, Bolivarian Republic of: Tracrium;
(ZA) South Africa: Atracurium | Tracrium;
(ZW) Zimbabwe: Tracrium

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Atracurium: Pediatric drug information