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Vecuronium Bromide

Pronouncation: (veh-CUE-row-nee-uhm BROE-mide)
Class: Nondepolarizing neuromuscular blocker

Trade Names:
Norcuron
- Powder for injection 10 mg
- Powder for injection 20 mg

Pharmacology

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Causes paralysis of skeletal muscles by binding competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.

Pharmacokinetics

Distribution

About 60% to 80% bound to plasma proteins. Distribution t _½ is about 4 min. Vd is 300 to 400 mL/kg.

Metabolism

One metabolite, 3-desacetyl vecuronium, has been recovered in urine of some patients in quantities that account for up to 10% of an injected dose. 3-desacetyl vecuronium also has been recovered by T-tube in some patients accounting for up to 25% of the injected dose.

Elimination

The t _½ is 65 to 75 min. In late pregnancy, the t _½ is about 35 to 40 min. Systemic rate of clearance is about 3 to 4.5 mL/min/kg. Urine recovery varies from 3% to 35% within 42 h.

Indications and Usage

Adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation.

Contraindications

Hypersensitivity to vecuronium or bromides.

Dosage and Administration

Adults & Children younger than 10 yr of age

Initial dose

Initial dose for inhalation 0.08 to 0.1 mg/kg. Reduce initial dose by 15% (0.06 to 0.85 mg/kg) if inhalation agents are already in use. If intubation is performed using succinylcholine, reduce initial dose to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia

Maintenance

IV bolus 0.01 to 0.015 mg/kg within 25 to 40 min of initial dose, then q 12 to 15 min.

IV infusion

1 mcg/kg/min initially beginning 20 to 40 min after IV bolus. Titrate to desired clinical response.

Children 1 to 10 yr of age

IV Slightly higher initial doses and more frequent supplementation.

Infants 7 wk to 1 yr of age

IV Slightly lower doses and 1.5 times less frequent.

General Advice

Administer IV only. Not for IM administration.
Administer only if intubation, artificial respiration, oxygen, and reversal agents are immediately available.
Reconstitute with sodium chloride 0.9%, dextrose 5%, dextrose 5% in saline, Lactated Ringer's solution, or sterile water for injection.
May reconstitute with bacteriostatic water for injection; however, when this diluent is used, solution contains benzyl alcohol and is contraindicated in newborns.

Storage/Stability

Store unopened vial at room temperature. Protect from light. Following reconstitution, refrigerate. Use within 8 h. Intended for single use only. Discard unused portions.

Drug Interactions

Aminoglycosides, verapamil, inhalation anesthetics (eg, enflurane, isoflurane), lincosamides (eg, clindamycin, lincomycin), magnesium salts, polypeptide antibiotics (eg, bacitracin, polymyxin B)

May enhance action of vecuronium (eg, respiratory depression).

Hydantoins, carbamazepine

May cause vecuronium to have shorter duration or decreased effectiveness.

Quinidine, quinine

Recurrent paralysis may occur with injection of quinidine during recovery from use of other muscle relaxants.

Theophyllines

Dose-dependent reversal of neuromuscular blockade is possible.

Thiopurines (eg, mercaptopurine)

May decrease or reverse vecuronium action.

Trimethaphan

May cause prolonged apnea.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Respiratory

Respiratory insufficiency; apnea.

Miscellaneous

Skeletal muscle weakness; profound and prolonged skeletal muscle paralysis.

Precautions

Warnings

Must be administered via trained personnel in an equipped facility to monitor, assist, and control respiration.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Infants are moderately more sensitive and take longer to recover. Not recommended in newborns; diluent contains benzyl alcohol (fatal-gasping syndrome).

Elderly

May experience delayed onset of action.

Circulatory disease (eg, cardiovascular disease, elderly, edematous states)

May cause delayed onset of action, do not increase dosage.

Consciousness

Vecuronium has no known effect on consciousness, pain threshold, or cerebration. Accompany administration of this drug by adequate anesthesia.

Electrolyte imbalance

Neuromuscular blockade may be altered depending on nature of imbalance.

Hepatic/Renal/Biliary disease

Prolonged neuromuscular blockade may occur due to reduced elimination. Higher doses may be needed due to increased volume of distribution.

Malignant hyperthermia

Monitor patient closely.

Myasthenia gravis

Small doses may have profound effects; administer test dose in monitoring response to muscle relaxants.

Severe obesity or neuromuscular disease

May pose airway or ventilation problems requiring special care before, during, or after vecuronium.

Overdosage

Symptoms

Skeletal muscle weakness, neuromuscular block beyond time needed, hypotension, decreased respiratory reserve, low tidal volume, apnea.

Patient Information

Explain to patient and family that patient will recover from anesthesia in 25 to 40 min.
Inform patient and family that patient may have difficulty speaking when recovering postoperatively but that speech will improve as effects of medication wear off.
Inform patient that postoperative urinary retention is possible.