Usual Adult Dose for Anesthesia

Dosage should be individualized. The dosing presented here is derived from studies and is intended only to serve as a guideline.

Skeletal Muscle Relaxation for Anesthesia/Caesarean section:

• Initially, 0.04 to 0.1 mg/kg IV followed by incremental doses starting at 0.01 mg/kg IV; these increments slightly increase the magnitude of the blockade and significantly increase the duration of blockade because a significant number of myoneural junctions are still blocked when there is need for more drug

Skeletal Muscle Relaxation for Endotracheal Intubation:

• A bolus dose of 0.06 to 0.1 mg/kg IV is recommended; conditions satisfactory for intubation are usually present within 2 to 3 minutes

Comments:

• Since potent inhalational anesthetics or prior use of succinylcholine may enhance the intensity and duration of this drug, the lower end of the recommended initial dosage range may suffice when this drug is first used after intubation with succinylcholine and/or after maintenance doses of volatile liquid inhalational anesthetics are started.
• To obtain maximum clinical benefits of this drug and to minimize the possibility of overdosage, the monitoring of muscle twitch response to a peripheral nerve stimulator is advised.

Use: As an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Usual Adult Dose for Cesarean Section

Dosage should be individualized. The dosing presented here is derived from studies and is intended only to serve as a guideline.

Skeletal Muscle Relaxation for Anesthesia/Caesarean section:

• Initially, 0.04 to 0.1 mg/kg IV followed by incremental doses starting at 0.01 mg/kg IV; these increments slightly increase the magnitude of the blockade and significantly increase the duration of blockade because a significant number of myoneural junctions are still blocked when there is need for more drug

Skeletal Muscle Relaxation for Endotracheal Intubation:

• A bolus dose of 0.06 to 0.1 mg/kg IV is recommended; conditions satisfactory for intubation are usually present within 2 to 3 minutes

Comments:

• Since potent inhalational anesthetics or prior use of succinylcholine may enhance the intensity and duration of this drug, the lower end of the recommended initial dosage range may suffice when this drug is first used after intubation with succinylcholine and/or after maintenance doses of volatile liquid inhalational anesthetics are started.
• To obtain maximum clinical benefits of this drug and to minimize the possibility of overdosage, the monitoring of muscle twitch response to a peripheral nerve stimulator is advised.

Use: As an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Usual Pediatric Dose for Anesthesia

Dosage should be individualized. The dosing presented here is derived from studies and is intended only to serve as a guideline. Children older than one month may be dosed the same as adults.

Neonates:

• Neonates are especially sensitive to nondepolarizing neuromuscular blocking agents. A test dose of 0.02 mg/kg IV should be given first in neonates to measure responsiveness.

Skeletal Muscle Relaxation for Anesthesia/Caesarean section:

• Initially, 0.04 to 0.1 mg/kg IV followed by incremental doses starting at 0.01 mg/kg IV; these increments slightly increase the magnitude of the blockade and significantly increase the duration of blockade because a significant number of myoneural junctions are still blocked when there is need for more drug

Skeletal Muscle Relaxation for Endotracheal Intubation:

• A bolus dose of 0.06 to 0.1 mg/kg IV is recommended; conditions satisfactory for intubation are usually present within 2 to 3 minutes

Comments:

• Since potent inhalational anesthetics or prior use of succinylcholine may enhance the intensity and duration of this drug, the lower end of the recommended initial dosage range may suffice when this drug is first used after intubation with succinylcholine and/or after maintenance doses of volatile liquid inhalational anesthetics are started.
• To obtain maximum clinical benefits of this drug and to minimize the possibility of overdosage, the monitoring of muscle twitch response to a peripheral nerve stimulator is advised.

Use: As an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Usual Pediatric Dose for Cesarean Section

Dosage should be individualized. The dosing presented here is derived from studies and is intended only to serve as a guideline. Children older than one month may be dosed the same as adults.

Neonates:

• Neonates are especially sensitive to nondepolarizing neuromuscular blocking agents. A test dose of 0.02 mg/kg IV should be given first in neonates to measure responsiveness.

Skeletal Muscle Relaxation for Anesthesia/Caesarean section:

• Initially, 0.04 to 0.1 mg/kg IV followed by incremental doses starting at 0.01 mg/kg IV; these increments slightly increase the magnitude of the blockade and significantly increase the duration of blockade because a significant number of myoneural junctions are still blocked when there is need for more drug

Skeletal Muscle Relaxation for Endotracheal Intubation:

• A bolus dose of 0.06 to 0.1 mg/kg IV is recommended; conditions satisfactory for intubation are usually present within 2 to 3 minutes

Comments:

• Since potent inhalational anesthetics or prior use of succinylcholine may enhance the intensity and duration of this drug, the lower end of the recommended initial dosage range may suffice when this drug is first used after intubation with succinylcholine and/or after maintenance doses of volatile liquid inhalational anesthetics are started.
• To obtain maximum clinical benefits of this drug and to minimize the possibility of overdosage, the monitoring of muscle twitch response to a peripheral nerve stimulator is advised.

Use: As an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Renal Dose Adjustments

Most of this drug and its metabolite are excreted in the urine. The elimination half-life is doubled and the plasma clearance is reduced in patients with renal failure. The rate of recovery of neuromuscular blockade is variable and sometimes much slower than normal which should be considered if this drug is used in a patient with renal failure.

Liver Dose Adjustments

Caution is recommended.

Precautions

US BOXED WARNINGS:
This drug should be administered only by adequately trained healthcare providers familiar with its actions, characteristics, and hazards.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

General:

• This drug should only be administered by experienced healthcare providers who are familiar with its actions and in facilities equipped with reversal agents, intubation, artificial respiration, and oxygen therapy. The clinician should be prepared to assist or control respiration.

IV compatibility:

• This drug should not be mixed with other agents in the same syringe, or with solutions for IV infusion because a change in pH may cause precipitation.

Frequently asked questions

• What is curare and what does it do?