A Comprehensive Monograph on Atracurium

Introduction and Drug Identification

Executive Summary

Atracurium is an intermediate-acting, non-depolarizing neuromuscular blocking agent (NMBA) of the benzylisoquinoline chemical class.[1] Its primary clinical function is to provide skeletal muscle relaxation as an adjunct to general anesthesia, thereby facilitating endotracheal intubation and optimizing surgical conditions.[1] It is also employed in intensive care unit (ICU) settings to support mechanical ventilation by inducing muscle paralysis.[1] The pharmacologic effect of atracurium is mediated through competitive inhibition of acetylcholine at postsynaptic nicotinic receptors located at the neuromuscular junction.[1] A defining characteristic of atracurium, and a principal reason for its development and enduring clinical utility, is its unique metabolic profile. It undergoes degradation in the plasma through two organ-independent pathways: Hofmann elimination, a spontaneous chemical process, and ester hydrolysis, catalyzed by non-specific esterases.[2] This mode of elimination makes its duration of action largely independent of renal or hepatic function, offering a significant safety advantage in patients with compromised organ systems.[5] Despite its benefits, the clinical use of atracurium requires vigilant monitoring due to its potential to cause dose-dependent histamine release and associated hemodynamic effects.[8]

Chemical and Regulatory Identifiers

To ensure precise identification across scientific, clinical, and regulatory domains, atracurium is cataloged under numerous standardized identifiers. The drug is most commonly administered as its besylate salt, also spelled besilate.[2] Key identifiers are consolidated in Table 1 below.

Physicochemical Properties and Structure