Drug Availability

HPS Pharmacies wish to give notice that Aspen Australia is experiencing a supply interruption for Tracrium® injection as follows:

Tracrium® Injection
Atracurium besilate 25mg/2.5mL
ARTG 11008

Other brands of atracurium are also unavailable. Normal supplies of Tracrium® 25mg/2.5mL are expected to resume on 22nd September 2018. Tracrium® 50mg/5mL is currently still available on restricted supply.

Atracurium is one of six non-depolarising neuromuscular blockers marketed in Australia. A summary of these agents, including the approximate onset and duration of action, can be found in Table 1. The duration of action is dose-related for these medications and may be prolonged in patients with renal or hepatic impairment. Times quoted are for recommended doses.

Table 1. Comparison of non-depolarising neuromuscular blockers

Drug

Onset (minutes)

Duration of action (minutes)

Availability

Initial Dose

Maintenance Dose

Benzylisoquinolinium Agents

Atracurium

1.5

30-40

15-25

50mg/5mL: Restricted supply

Cisatracurium

2

30-40

20

Available

Mivacurium

2-2.5

15-30

15

Available

Aminosteroid Agents

Pancuronium

1.5-2.5

60-120

25-60

22nd October 2018

Rocuronium

1

30-40

15-20

Available

Vecuronium

2-3

20-40

20-40

Available

Atracurium belongs to the benzylisoquinolinium class of neuromuscular blockers. These agents lack vagolytic effects at recommended doses and, therefore, do not usually have clinically significant effects on heart rate. Other available agents in this class which could be considered include cisatracurium and mivacurium. The duration of block produced by mivacurium may be significantly prolonged in patients with renal or hepatic impairment. In contrast, termination of the neuromuscular blocking action of atracurium and cisatracurium is not dependent on renal or hepatic function.

The appropriate product information should be consulted for further information before an alternative agent is selected.

Retain this notice in a prominent position, including in other related business units until supplies return to normal. Report any problems identified with medicines, vaccines or medical devices to the TGA.

Should you require further information regarding this matter, please contact your pharmacist at HPS Pharmacies, or Aspen Australia on 1300 659 646.

References:

  1. Rossi S, editor. Non-depolarising neuromuscular blockers. In: Australian Medicines Handbook 2018 [online]. Adelaide: Australian Medicines Handbook Pty Ltd; 2018.
  2. Tracrium® Injection (atracurium besilate). Australian approved product information. St Leonards: Aspen Pharmacare Australia. Approved November 2017.

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