[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/) › Atracurium [Pharmacology](https://durgical.com/en/pharmacology/) · [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/) # Atracurium Non-depolarising muscle relaxant that breaks down by itself in the blood (Hofmann elimination): useful in liver or kidney failure. It releases histamine. Updated 2026-11-01 - Class: [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/) - Receptor: Muscle nicotinic acetylcholine receptor (motor end plate) - ATC code: M03AC04 - WHO Model List of Essential Medicines ## ⚠ High-alert medication An error with this medicine can cause serious harm: double checks and protocols are used. Also called: Atracurium besilate ◎**Muscle nicotinic acetylcholine receptor (motor end plate)**Atracurium ⓘ There is no structure with atracurium. The figure shows d-tubocurarine, another benzylisoquinoline, at the acetylcholine site of the Torpedo ray muscle-type nicotinic receptor. **Target in 3D:** Muscle nicotinic acetylcholine receptor (motor end plate). PDB structure 7SMS (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7SMS) · Drag to rotate · pinch to zoom ## Mechanism of action Atracurium, a benzylisoquinoline, competes with acetylcholine at the nicotinic receptor of the motor end plate without activating it. Its distinctive feature is elimination: it breaks down in plasma by ester hydrolysis and by Hofmann elimination, a chemical process that does not depend on enzymes, the liver or the kidney and occurs at physiological pH. One of its products is laudanosine. - Competes with acetylcholine at the nicotinic receptor - Flaccid paralysis of intermediate duration - Breaks down in blood (Hofmann and esters) without liver or kidney - Releases histamine with high doses or rapid injection ## Pharmacokinetics **Metabolism** Hofmann elimination (chemical, non-enzymatic) and hydrolysis by non-specific esterases; produces laudanosine. **Elimination** The metabolites leave in urine and bile; duration barely changes with renal or hepatic failure. ## Indications - Tracheal intubation and muscle relaxation in surgery - Patients with liver or kidney failure who need neuromuscular block ## Adverse effects ### Common - Skin flushing - Transient hypotension - Tachycardia ### Serious (rare, important) - Histamine release with bronchospasm and hypotension - Anaphylaxis - Seizures with prolonged ICU infusions (laudanosine may play a role) - Prolonged weakness in the ICU ## Contraindications - Hypersensitivity to atracurium - Multiple-dose vials with benzyl alcohol: hypersensitivity to benzyl alcohol; avoided in newborns ## Key interactions **Halogenated agents, aminoglycosides, magnesium, lithium** Enhance the block. **Alkaline solutions (barbiturates)** Incompatible; atracurium is inactivated or precipitates. ## What is monitored - Train-of-four - Blood pressure and signs of histamine release (flushing, bronchospasm) - Ventilation and saturation ## Administration and safety - Keep refrigerated and protected from light; at room temperature it loses potency. - In patients with heart disease or a history suggesting a higher risk of histamine release (asthma, anaphylactoid reactions), it is injected more slowly. - Do not mix with alkaline solutions in the same syringe or line. - Paralysing agent: store apart with warnings. ## Nursing care - Watch blood pressure, flushing and wheeze after injection. - Train-of-four and sedation assessment. - With long ICU infusions: watch for seizures. - After reversal: strength, breathing and saturation. ## Pregnancy and breastfeeding Small amounts cross the placenta; it has been used for caesarean sections without attributable effects in the newborns, who are watched for respiratory depression. ## Memory aid Atracurium and Hofmann: it «self-destructs» in the blood; liver and kidney do not matter, but it lets out histamine. ## Test yourself Think of the answer, then tap the question to see it. ## What is Hofmann elimination? A spontaneous, non-enzymatic chemical breakdown that occurs in plasma at physiological pH; it eliminates atracurium and cisatracurium. ## Why is atracurium useful in liver or kidney failure? Its elimination does not depend on those organs: it breaks down in the blood by Hofmann elimination and esterases. ## Which atracurium metabolite can cause cerebral excitation? Laudanosine, which causes seizures at high doses in animals. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/atracurium/) ## Related drugs - [Cisatracurium](https://durgical.com/en/pharmacology/cisatracurium/) - [Rocuronium](https://durgical.com/en/pharmacology/rocuronium/) [← Back to the class: Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - ATRACURIUM BESYLATE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=de1c2dcd-295b-47ce-b7a1-a8be59939a54) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 13 (McGraw Hill, 2023); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=M03AC04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/atracurium/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/atracurium/