Vecuronium bromide

Generic Medicine Info
Indications and Dosage
Facilitate endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 100 mcg/kg by inj. Maintenance: 20-40 mcg/kg by inj or as continuous infusion at 0.8-1.4 mcg/kg/min. Surgical procedures after intubation with suxamethonium: 40-60 mcg/kg. Surgery under halothane and neuroleptic anaesthesia: Initially, 150-400 mcg/kg.
Child: >7 weeks to <1 year Same with adult but use of high doses is not required and requirement of maintenance dose is less frequent; 2-10 years Same initial and maintenance doses as for adults, but maintenance doses are required more frequently.
Special Patient Group
Obese patients (≥130% of ideal body wt): Reduce dose, taking into account an ideal body wt.
Add 10 mL or 20 mL of bacteriostatic water for inj to a vial containing 10 mg or 20 mg of the drug, respectively, to provide a soln containing 1 mg/mL. Further dilute to the desired concentration (usually, 0.1-0.2 mg/mL) to be used for IV infusion.
Furosemide, alkaline soln (e.g. thiopental).
Special Precautions
Patient w/ CV disease, oedema, neuromuscular disease, previous poliomyelitis, burn injury, severe electrolyte disturbances, altered blood pH, dehydration; obese patient. Hepatic and renal impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Skeletal muscle weakness or paralysis, resp insufficiency or apnoea, bronchospasm, hypotension, tachycardia, acute urticaria, erythema, minimal induration, redness, itching, CV effects (e.g. changes in heart rate, cardiac index), myopathy.
Potentially Fatal: Anaphylaxis.
IV/Parenteral: C
Monitoring Parameters
Monitor BP, heart rate; peripheral nerve stimulation.
Symptoms: Skeletal muscle weakness, decreased resp reserve, low tidal vol, apnoea. Management: Maintain a patent airway w/ manual or mechanical ventilation. May administer pyridostigmine, neostigmine or edrophonium in conjunction w/ atropine or glycopyrrolate to antagonise the muscle relaxant effect.
Drug Interactions
Increased effect w/ halogenated volatile anaesth (e.g. enflurane, isoflurane, halothane), certain antibiotics (e.g. aminoglycosides, lincosamide and polypeptide antibiotics, acylamino-penicillin antibiotics), diuretics, quinidine, Mg and lithium salts, Ca channel blockers, cimetidine, lidocaine and acute admin of phenytoin or β-blockers. Decreased effect w/ phenytoin and carbamazepine (chronic use), Ca and K salts.
Mechanism of Action: Vecuronium competes w/ acetylcholine for cholinergic receptor sites, binding w/ nicotinic receptor at the motor end-plate, resulting to neuromuscular blockade.
Onset: Good intubation conditions: W/in 2.5-3 min. Max neuromuscular blockade: W/in 3-5 min.
Duration: Under balanced anaesth (time to recovery to 25% of control): 25-40 min; recovery 95% complete, approx 45-65 min after inj of intubating dose.
Distribution: Rapidly distributed into extracellular space. Volume of distribution: 0.3-0.4 L/kg. Plasma protein binding: 60-80%.
Metabolism: Undergoes partial hepatic metabolism via spontaneous deacetylation to form the active metabolite 3-desacetyl vecuronium.
Excretion: Mainly via bile (as unchanged drug and metabolites), some in urine. Plasma elimination half-life: Approx 30-80 min.
Chemical Structure

Chemical Structure Image
Vecuronium bromide

Source: National Center for Biotechnology Information. PubChem Database. Vecuronium bromide, CID=39764, (accessed on Jan. 23, 2020)

Store between 20-25°C. Protect from light.
MIMS Class
Neuromuscular Blocking Agents
ATC Classification
M03AC03 - vecuronium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
Anon. Vecuronium Bromide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. Accessed 05/08/2015.

Buckingham R (ed). Vecuronium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. Accessed 05/08/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Vecuronium Bromide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). Accessed 05/08/2015.

Vecuronium Bromide Injection, Lyophilized Powder for Solution (Mylan Institutional LLC). DailyMed. Source: U.S. National Library of Medicine. Accessed 05/08/2015.

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