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Pronunciation: veh-CUE-row-nee-uhm BROE-mide
Class: Nondepolarizing neuromuscular blocker
- Powder for injection 10 mg
- Powder for injection 20 mg
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.
About 60% to 80% bound to plasma proteins. Distribution t ½ is about 4 min. Vd is 300 to 400 mL/kg.
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.
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.
Hypersensitivity to vecuronium or bromides.
Dosage and AdministrationAdults & Children younger than 10 yr of age
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 anesthesiaMaintenance
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.
- 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.
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 InteractionsAminoglycosides, 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.
Respiratory insufficiency; apnea.
Skeletal muscle weakness; profound and prolonged skeletal muscle paralysis.
Must be administered via trained personnel in an equipped facility to monitor, assist, and control respiration.
Category C .
Infants are moderately more sensitive and take longer to recover. Not recommended in newborns; diluent contains benzyl alcohol (fatal-gasping syndrome).
May experience delayed onset of action.
Circulatory disease (eg, cardiovascular disease, elderly, edematous states)
May cause delayed onset of action, do not increase dosage.
Vecuronium has no known effect on consciousness, pain threshold, or cerebration. Accompany administration of this drug by adequate anesthesia.
Neuromuscular blockade may be altered depending on nature of imbalance.
Prolonged neuromuscular blockade may occur due to reduced elimination. Higher doses may be needed due to increased volume of distribution.
Monitor patient closely.
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.
Skeletal muscle weakness, neuromuscular block beyond time needed, hypotension, decreased respiratory reserve, low tidal volume, apnea.
- 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.
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