Atracurium Besylate

證據等級: L5

預測適應症: 10 個

Atracurium Besylate: From Neuromuscular Blockade to Preeclampsia

One-Sentence Summary

Atracurium besylate is a non-depolarising neuromuscular blocking agent (NMB) widely used in anaesthesia to facilitate endotracheal intubation and maintain skeletal muscle relaxation during surgical procedures, including in pregnant patients. The TxGNN model predicts it may be effective for Preeclampsia, with 0 clinical trials and 4 publications identified in the evidence search — however, critical review reveals that none of these studies evaluate atracurium as a treatment for preeclampsia; they describe its use as an anaesthetic adjunct administered to preeclamptic patients undergoing caesarean section.

Quick Overview

Item	Content
Original Indication	Neuromuscular blockade during anaesthesia and surgical procedures (not registered in Singapore; known from medical literature)
Predicted New Indication	Preeclampsia
TxGNN Prediction Score	99.97%
Evidence Level	L4
Singapore Market Status	Not marketed
Number of Registrations	0
Recommended Decision	Hold

Why is This Prediction Reasonable?

Currently, detailed mechanism of action data is not available in this Evidence Pack. Based on established pharmacology, atracurium besylate is a competitive antagonist of nicotinic acetylcholine receptors (nAChR) at the skeletal neuromuscular junction, producing reversible, dose-dependent muscle paralysis. Its defining pharmacokinetic property is Hofmann elimination — a spontaneous, pH- and temperature-dependent degradation process that is independent of renal or hepatic function — making it particularly suitable for patients with end-organ compromise, including those with preeclampsia-related organ dysfunction.

The high TxGNN score most likely reflects clinical co-occurrence rather than therapeutic potential: preeclamptic patients who require emergency caesarean section under general anaesthesia routinely receive atracurium as part of the standard anaesthetic protocol. The knowledge graph likely captures this frequent association between the drug and the disease context. Preeclampsia itself is a hypertensive disorder of pregnancy driven by placental endothelial dysfunction, and its management relies on antihypertensives (labetalol, hydralazine, nifedipine) and magnesium sulphate (MgSO₄) for seizure prophylaxis — mechanisms entirely unrelated to neuromuscular blockade.

A clinically important safety signal exists in this pairing: MgSO₄, the first-line therapy for preeclampsia/eclampsia prophylaxis, potentiates the neuromuscular blocking effect of atracurium and can significantly prolong its duration of action. This pharmacodynamic interaction requires dose reduction and enhanced neuromuscular monitoring when both agents are co-administered — further confirming that atracurium's presence in preeclampsia-related literature represents an anaesthetic management consideration, not a repurposing opportunity.

Clinical Trial Evidence

Currently no related clinical trials registered for atracurium in the treatment of preeclampsia.

Literature Evidence

PMID	Year	Type	Journal	Key Findings
3778800	1986	Case Series	British Journal of Anaesthesia	Clinical observation of atracurium use in pre-eclamptic patients; describes safe administration as NMB adjunct during anaesthesia, not as a treatment for preeclampsia
9646009	1998	PK/PD Review	Clinical Pharmacokinetics	Pharmacokinetics of NMBs (including atracurium) during pregnancy; notes that volume of distribution and clearance via Hofmann elimination are unchanged in pregnant patients
18383970	2008	Case Series	Revista Española de Anestesiología y Reanimación	Remifentanil for haemodynamic control during C-section in high-risk patients (including severe preeclampsia ineligible for spinal anaesthesia); atracurium used as background NMB in the general anaesthesia protocol
41103680	2025	RCT (anaesthesia comparison)	Anesthesiology and Pain Medicine	Comparison of IL-6, leptin, and adiponectin levels after C-section under general vs. spinal anaesthesia; atracurium included as part of the general anaesthesia regimen, not the study intervention

Safety Considerations

Please refer to the package insert for safety information.

Clinically Important Interaction: Magnesium sulphate (MgSO₄), the standard prophylactic therapy for preeclampsia-related seizures, is known to significantly potentiate neuromuscular blockade from atracurium. If atracurium is used in any preeclampsia context, dose reduction and continuous neuromuscular monitoring are required.

Conclusion and Next Steps

Decision: Hold

Rationale: The TxGNN prediction for atracurium in preeclampsia is assessed as a false positive driven by clinical co-occurrence: atracurium appears in preeclampsia-related literature solely as an anaesthetic adjunct, not as a therapeutic agent. There is no biological mechanism linking neuromuscular junction blockade to the core pathophysiology of preeclampsia (placental ischaemia, endothelial dysfunction, hypertension, proteinuria), and no clinical trial has ever evaluated atracurium as a repurposing candidate for this indication. Across all 10 TxGNN-predicted indications for this drug, the same pattern holds — the model captures perioperative context, not therapeutic signal.

To proceed, the following is needed:

Retrieve the full product SmPC / package insert (originator source or HSA equivalent) to document contraindications, warnings, and dosing — currently a blocking data gap
Obtain DrugBank MOA entry for DB00732 to formally confirm pharmacological classification
No further repurposing investigation is recommended for the drug–preeclampsia pair or any of the 10 predicted indications in this pack; this candidate should be flagged as low-priority and archived pending any future mechanistic evidence
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.