Vecuronium Bromide (vecuronium bromide)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Vecuronium bromide is an aminosteroid nondepolarizing neuromuscular blocking agent.
Vecuronium bromide is a nondepolarizing neuromuscular blocking agent that produces pharmacologic effects similar to those of other nondepolarizing neuromuscular blocking agents. The drug acts by competing for cholinergic receptors at the motor end-plate. Vecuronium appears to have little histamine-releasing activity when administered at usual clinical doses.
Unlike other nondepolarizing neuromuscular blocking agents, vecuronium has no clinically significant effects on hemodynamic parameters and does not significantly impact blood pressure, heart rate, cardiac output, systemic vascular resistance, or pulmonary capillary wedge pressure.
The manufacturer states that the ED90 (dose required to produce 90% suppression of the control twitch response) of vecuronium in patients undergoing balanced anesthesia averages 0.057 mg/kg; in several studies in patients undergoing balanced anesthesia, the ED90 has ranged from 0.049-0.062 mg/kg.
The onset and duration of, and the rate of recovery from, neuromuscular blockade induced by vecuronium vary among individuals, are dose dependent, and may be altered by the anesthetic agent (e.g., enflurane, isoflurane, halothane) employed. The time from injection to onset of neuromuscular blockade decreases as the dose of vecuronium bromide increases. The manufacturer states that following IV administration of a vecuronium bromide dose of 0.08-0.1 mg/kg, neuromuscular blockade begins within 1 minute and is maximal at 3-5 minutes; good to excellent intubating conditions typically occur within 2.5-3 minutes.
The duration of neuromuscular blockade increases as the dose of vecuronium bromide increases. The manufacturer states that the duration of clinically sufficient neuromuscular blockade (i.e., time from injection to 25% spontaneous recovery of control twitch response) induced by initial vecuronium bromide doses of 0.08-0.1 mg/kg under balanced anesthesia is about 25-40 minutes, and the duration of vecuronium-induced blockade (time from injection to 95% spontaneous recovery of control twitch response) is approximately 45-65 minutes. Repeated administration of maintenance doses of vecuronium bromide appears to have little, if any, cumulative effect on duration of the neuromuscular blockade.
In addition, since the time necessary to recover from maintenance doses of the same size generally does not change with each additional dose, doses may be administered at relatively regular intervals with predictable neuromuscular blocking results. The manufacturer states that the recovery time (the time necessary for spontaneous recovery of the twitch response from 25% to 75% of the control response) following administration of vecuronium bromide doses of 0.08-0.1 mg/kg under balanced or halothane anesthesia is about 15-25 minutes.
Vecuronium is approximately 60-80% bound to plasma proteins. The distribution half-life following a single IV dose of 0.025-0.28 mg/kg is approximately 4 minutes, and elimination half-life is approximately 65-75 minutes in healthy surgical patients and renal failure patients undergoing transplant surgery. In late pregnancy, the elimination half-life may be decreased to approximately 35-40 minutes.
In aqueous solution in vitro, vecuronium undergoes spontaneous deacetylation at the 3alpha- and/or 17beta-positions to form the hydroxy derivatives; following use of vecuronium during surgery, only unchanged vecuronium has been detected in human plasma, but the 3-desacetyl vecuronium metabolite has been rarely detected in human plasma following prolonged vecuronium use in the intensive care unit. The neuromuscular blocking activity of the 3alpha-hydroxy derivative appears to be at least 50% that of the unchanged drug. In vitro, the 3alpha-hydroxy derivative undergoes rapid conversion to the 3alpha,17beta-dihydroxy derivative.
Vecuronium and its metabolite(s) appear to be excreted principally in feces via biliary elimination; the drug and its metabolite(s) are also excreted in urine. Approximately 3-35% of an IV dose of vecuronium bromide is excreted in urine within 24 hours after administration in humans. In patients with a T-tube in the common bile duct, 25-50% of an IV dose of vecuronium was reportedly excreted in bile within 42 hours after administration.
The 3-desacetyl vecuronium metabolite has been recovered in the urine of some patients in quantities that account for up to 10% of the injected dose; 3-desacetyl vecuronium has also been recovered by T-tube in some patients, accounting for up to 25% of the injected dose.
Generic name: vecuronium bromide
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Vecuronium Bromide
Indications
The following indications are listed for Vecuronium Bromide:
- General Anesthesia Adjunct
- Muscle Relaxation
- Skeletal Muscle Relaxation For Endotracheal Intubation
Also known as: Adjunct General Anesthesia, Muscle Flaccidity, Skeletal Muscle Relaxation For Endotracheal Tube Insertion, Skeletal Muscle Relaxation For Intratracheal Intubation, Skeletal Muscle Relaxation For Intubation Of Trachea.
Dosing
Dosage of vecuronium bromide is expressed in terms of the salt. The dosage must be carefully adjusted according to individual requirements and response. The use of a peripheral nerve stimulator is recommended to accurately monitor the degree of neuromuscular blockade and recovery, determine the need for additional doses, determine the adequacy of spontaneous recovery or antagonism, and minimize the complications of overdosage if additional doses are administered.
A reduction in the dosage of vecuronium bromide may be required in patients receiving general anesthetics (e.g., enflurane, isoflurane) that potentiate its neuromuscular blocking activity. Potentiation is minimal when vecuronium is administered prior to these anesthetics.
Vecuronium bromide is administered IV only.
The initial (intubating) dose is administered by rapid IV injection; maintenance doses may be administered by intermittent IV injection or by continuous IV infusion.
Store unopened vials of vecuronium bromide for injection at 20-25degreesC; protect vials from light and store in the original carton until the time of use.
For IV injection, commercially available vecuronium bromide for injection should be reconstituted with a compatible IV solution (e.g., 5% dextrose, 5% dextrose and 0.9% sodium chloride, 0.9% sodium chloride, Lactated ringer's, bacteriostatic water for injection, sterile water for injection). When reconstituted with bacteriostatic water for injection, the solution should be stored at room temperature or under refrigeration and used within 5 days; when reconstituted with other compatible solutions, the solution should be stored under refrigeration and used within 24 hours (any unused portions after this time period should be discarded).
For continuous IV infusion, the reconstituted vecuronium solution should be further diluted to the desired concentration (usually 0.1 or 0.2 mg/mL) in a compatible IV infusion solution such as 5% dextrose, 5% dextrose and 0.9% sodium chloride, 0.9% sodium chloride, or Lactated ringer's.
Reconstituted solutions of vecuronium and diluted solutions of the drug should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Vecuronium should not be mixed in the same syringe nor administered simultaneously through the same needle as an alkaline solution (e.g., barbiturate solution).
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*Known hypersensitivity to vecuronium bromide.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
Adverse effects of vecuronium bromide generally are manifestations of the drug's pharmacologic action beyond the time period needed; this may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiration insufficiency or apnea.
There have also been postmarketing reports of severe allergic reactions (anaphylactic and anaphylactoid reactions) associated with neuromuscular blocking agents, including vecuronium; in some cases, these reactions have been life-threatening or fatal.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
No enhanced messaging available.
The safety and effectiveness of vecuronium have been established in pediatric patients >=7 weeks of age. Infants 7 weeks to 1 year of age are moderately more sensitive to vecuronium on a mg/kg basis than adults and take approximately 1.5 times as long to recover. Pediatric patients 1 to <10 years of age may require a slightly higher initial dosage and may require slightly more frequent maintenance doses than adult patients.
Animal reproduction studies have not been conducted with vecuronium. It is not known whether vecuronium can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Administer vecuronium to a pregnant woman only if clearly needed.
The use of vecuronium in patients undergoing cesarean section has been reported; the umbilical venous plasma concentrations were 11% of maternal concentrations at delivery and mean neonate APGAR scores at 5 minutes were >=9. The action of neuromuscular blocking agents may be enhanced by magnesium salts administered for the management of preeclampsia.
Vecuronium crosses the placenta minimally.
It is not known whether vecuronium is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when vecuronium is administered to a breast-feeding woman.
The manufacturer recommends cautious dosage selection in elderly patients, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function in this patient population. Advanced age or other conditions associated with slower circulation time may result in delayed onset of neuromuscular blockade; however, the manufacturer does not recommend increasing the dosage of vecuronium bromide to reduce onset time, as higher dosages produce a longer duration of action. Close monitoring of neuromuscular function is recommended when vecuronium is administered in geriatric patients.
Clinical studies of vecuronium did not include sufficient numbers of patients >=65 years of age to determine whether they respond differently from younger patients. Some published studies report an increased effect and longer duration of action for vecuronium in geriatric patients compared with younger patients; however, other reports have found no significant differences between healthy elderly patients and younger adults. Advanced age or other conditions associated with slower circulation time may be associated with a delay in onset of action; however, recommended doses of vecuronium bromide should not be increased to reduce onset time, as higher doses produce a longer duration of action.
Select dosage cautiously in geriatric patients and monitor neuromuscular function closely.
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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