Tracrium - Atracurium besylate

Atracurium besylate (Tracrium) is a benzylisoquinolin-ium compound like d-tubocurarine. Its actions are similar to those of d-tubocurarine, but its duration of action is shorter (45 minutes) because of spontaneous degradation of the molecule (Hofmann elimination). Because of this, atracurium is useful in patients with low or atypical plasma cholinesterase and in patients with renal or hepatic impairment. 

The drug PO incorporates aspects of the first three items in the preceding shopping list with some success. Acetate hydrolysis, as the metabolic inactivation route, however, fails to meet the requirements of item 4. The introduced atracurium besylate (Tracrium, Fig. 8-15), however, does meet the requirements. The following discussion then will pertain to the chemical logic that went into the design of atracurium. 

B. Atracurium besylate (Tracrium), 10 mg/mL in 5-mL single-dose and 10-mL multidose vials (with benzyl alcohol). The suggested minimum stocking level to treat a 70-kg adult for the first 24 hours is four 10-mL vials. 

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