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Atracurium: Drug information

Atracurium: Drug information
(For additional information see "Atracurium: Patient drug information" and see "Atracurium: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Pharmacologic Category
  • Neuromuscular Blocker Agent, Nondepolarizing
Dosing: Adult

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

Mechanically ventilated patients during surgery, neuromuscular blockade

Mechanically ventilated patients during surgery, neuromuscular blockade (adjunctive therapy):

Note: Inhaled anesthetic agents (eg, desflurane, isoflurane, enflurane, sevoflurane) prolong the duration of action of atracurium. Use lower end of the dosing range; redosing interval guided by monitoring with a peripheral nerve stimulator.

Initial: IV: Loading dose of 0.25 to 0.6 mg/kg (Ref).

Maintenance:

Intermittent dosing: IV: 0.08 to 0.1 mg/kg every ~15- to 25-minute intervals according to desired clinical response.

Continuous infusion: IV: Initial: 4 to 12 mcg/kg/minute; titrate based on response; usual dosage range: 2 to 15 mcg/kg/minute (Ref).

Mechanically ventilated patients in the ICU, neuromuscular blockade

Mechanically ventilated patients in the ICU, neuromuscular blockade:

Note: May use to facilitate mechanical ventilation (eg, moderate to severe acute respiratory distress syndrome [ARDS]), for refractory, life-threatening status asthmaticus, or for shivering from therapeutic hypothermia (Ref).

Continuous infusion: IV: Initial: Loading dose of 0.4 to 0.6 mg/kg, followed by continuous infusion of 4 to 12 mcg/kg/minute; adjust rate every ~10 minutes according to desired clinical response and/or peripheral nerve stimulation; usual dosage range: 2 to 20 mcg/kg/minute (Ref).

Intermittent dosing: IV: Initial: Loading dose of 0.4 to 0.6 mg/kg, followed by 0.08 to 0.1 mg/kg every ~15 to 25 minutes according to desired clinical response (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: Hepatic Impairment: Adult

No dosage adjustment necessary.

Dosing: Obesity: Adult

Obese and morbidly obese patients should be dosed using ideal body weight or an adjusted body weight (ie, between IBW and total body weight [TBW]) (Ref). In a bariatric surgical population of morbidly obese patients who were administered an induction dose of atracurium based on TBW as compared to IBW, time to recovery of twitch response was prolonged (Ref).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Atracurium: Pediatric drug information")

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: Hepatic Impairment: Pediatric

Infants, Children, and Adolescents: 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: 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.

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.

Usual Infusion Concentrations: Adult

IV infusion: 20 mg in 100 mL (concentration: 0.2 mg/mL) or 50 mg in 100 mL (concentration: 0.5 mg/mL) or 250 mg in 250 mL (concentration: 1 mg/mL) or 500 mg in 100 mL (concentration: 5 mg/mL) of D5W, D5NS, or NS.

Use: Labeled Indications

Mechanically ventilated patients during surgery, neuromuscular blockade: As an adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery.

Mechanically ventilated patients in the ICU, neuromuscular blockade: To facilitate endotracheal intubation and to provide skeletal muscle relaxation mechanical ventilation in ICU patients.

Note: Neuromuscular blockade does not provide pain control, sedation, or amnestic effects. Appropriate analgesic and sedative mediations should be used before and during administration of neuromuscular blockade to achieve deep sedation.

Medication Safety Issues
High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Other safety concerns:

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. This includes:

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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Aminoglycosides: May enhance the therapeutic effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bacitracin (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Botulinum Toxin-Containing Products: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bromperidol: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Calcium Channel Blockers: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

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

Cardiac Glycosides: Neuromuscular-Blocking Agents may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy

Clindamycin (Topical): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Colistimethate: May enhance the neuromuscular-blocking effect 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 enhance the adverse neuromuscular effect 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 enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Fosphenytoin-Phenytoin: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may decrease the serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Inhalational Anesthetics: May enhance the neuromuscular-blocking effect 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

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

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

Lincosamide Antibiotics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Lithium: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Local Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Loop Diuretics: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Magnesium Salts: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Pholcodine: May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents. Specifically, anaphylaxis has been reported. Risk C: Monitor therapy

Polymyxin B: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of neuromuscular-blocking agents and polymyxin B. If concomitant use cannot be avoided, monitor for deeper, prolonged neuromuscular-blocking effects (eg, respiratory paralysis) in patients receiving this combination. Risk D: Consider therapy modification

Procainamide: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

QuiNIDine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

QuiNINE: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk X: Avoid combination

Tetracyclines: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Thiazide and Thiazide-Like Diuretics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Trimebutine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Vancomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Pregnancy Considerations

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

Breastfeeding Considerations

It is not known if atracurium is present in breast milk. The manufacturer recommends that caution be exercised when administering atracurium to breastfeeding women.

Monitoring Parameters

Vital signs (heart rate, blood pressure, respiratory rate); degree of muscle paralysis (eg, presence of spontaneous movement, ventilator asynchrony, shivering, and consider use of a peripheral nerve stimulator with train of four monitoring along with clinical assessments)

In the ICU setting, limiting the duration of paralysis and providing a physiotherapy regimen in patients requiring continuous paralysis is suggested.

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): Vd:

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 northia | Atracurium pharmavial | Gelolagar | Tracuron;
  • (AT) Austria: Atracurium hameln | Atracuriumbes deltaselect | Tracrium;
  • (AU) Australia: Atracurium;
  • (BD) Bangladesh: Atrelax | Tracrium;
  • (BE) Belgium: 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 | 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 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: 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;
  • (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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