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Vecuronium Bromide information from DrugsUpdate  

See Available Brands of Vecuronium Bromide in India

P - Caution when used during pregnancy
L - Caution when used during lactation

Vecuronium (Norcuron) is a muscle relaxant in the category of non-depolarizing blocking agents. Vecuronium bromide is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Although vecuronium bromide is often thought of as a muscle relaxant, it may be more accurate to classify it as a paralyzing agent. It is commercially available as ampoules containing 4 mg of the drug in powder form which needs to be dissolved in distilled water prior to administration to the patient. In India, vials containing 10 mg of vecuronium bromide are also commercially available, for use in patients undergoing prolonged surgical procedures.

Pharmacodynamics

Pharmacokinetics

Vecuronium bromide inhibits depolarisation by blocking acetylcholine from binding to receptors on motor endplate.

Onset
1.5-2 minutes.

Duration
20-30 minutes.

Metabolism
Hepatic; yielding metabolites also possessing neuromuscular blocking activity.

Excretion
Via bile (as unchanged drug and metabolites), via urine (trace amounts); 30-80 minutes (elimination half-life).

Vecuronium Bromide Indications / Vecuronium Bromide Uses

Information Not Available

Vecuronium Bromide Adverse Reactions / Vecuronium Bromide Side Effects

Muscle weakness, paralysis, muscle atrophy (after long term use), hypersensitivity reactions e.g urticaria and erythema.

Potentially Fatal: Anaphylaxis, respiratory failure, apnoea.

Precautions

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

Overdosage
Symptoms: Mainly extensions of the usual pharmacologic effects of the drug. Skeletal muscle weakness, decreased respiratory reserve, low tidal volume, or apnea. A peripheral nerve stimulator may be used to monitor recovery from blockade and to differentiate between prolonged neuromuscular blockade from other causes of diminished respiratory reserve. Management: Treatment is supportive and symptomatic. Maintain an adequate, patent airway using assisted or controlled respiration. Neuromuscular blockade may be reversed by admin of a cholinesterase inhibitor such as neostigmine, pyridostigmine or edrophonium.

Special Precautions

Pregnancy, lactation, elderly. Renal and hepatic impairment. Increase in onset time in conditions associated with prolonged circulation time (e.g. CV disease, oedema). Neuromuscular disease e.g. myasthenia gravis, Eaton-Lambert syndrome or after poliomyelitis. Hypothermia, burns patients. Decrease dose in obese patients, taking into account lean body-mass. Correct severe electrolyte disturbances, altered blood pH, dehydration where possible before vecuronium admin. Do not use potentially dangerous machinery or drive a car within 24 hours after full recovery from the neuromuscular blocking action of vecuronium. Do not admin vecuronium unless facilities for intubation, artificial respiration, oxygen therapy and agents for neuromuscular reversal are immediately available.

Other Drug Interactions

Increases neuromuscular blockade with volatile anaesthetic agents (halothane, ether, enflurane, isoflurane, methoxyflurane, propofol and cyclopropane), fentanyl, other non-depolarising muscle relaxants, prior admin of succinylcholine, tetracyclines, polymyxins, diuretics, thiamine, MAOIs, bacitracin, colistin, sodium colistimethate, acylaminopenicillins, aminoglycoside antibiotics, high dose metronidazole, protamine, β-adrenergic blocking agents, calcium antagonists e.g. verapamil, and Mg. Decreased neuromuscular blockade with anticholinesterases, prior chronic admin of corticosteroids, phenytoin, carbamazepine, noradrenaline, azathioprine, theophylline, calcium chloride.

Other Interactions

Information Not Available

Dosage

Intravenous
Muscle relaxant in general anaesthesia, Facilitate endotracheal intubation
Adult: Initially, 80-100 mcg/kg given as injection (reduced doses at 30-50 mcg/kg have been suggested after use of suxamethonium; not to exceed 100 mcg/kg in caesarean and neonatal surgery). Maintenance in prolonged procedure: 20-30 mcg/kg, adjust according to response. Alternatively, as continuous infusion: 0.8-1.4 mcg/kg/minute after initial IV dose of 40-100 mcg/kg.
Child: < 5 months: Initially, 10-20 mcg/kg, increased if necessary according to response. > 5 months: initially, 80-100 mcg/kg given as injection; alternatively, 30-50 mcg/kg after clinical recovery from neuromuscular blockade of suxamethonium. Max in caesarean and neonatal surgery: 100 mcg/kg. Maintenance in prolonged procedure: 10-15 mcg/kg.
Elderly: Dose reduction may be needed.


Renal impairment: Dose adjustments may be needed.
Hepatic impairment: Dose adjustments may be needed.

Incompatibility
Incompatible with furosemide, alkaline solution e.g. thiopental sodium.

Food(before/after)

Information Not Available

List of Contraindications

Vecuronium Bromide and Pregnancy

Caution when used during pregnancy

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Vecuronium Bromide and Lactation

Caution when used during lactation

Vecuronium Bromide and Children

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

Vecuronium Bromide and Geriatic

May experience delayed onset of action

Vecuronium Bromide and Other Contraindications

Hypersensitivity to vecuronium or bromide

Storage

Information Not Available

Lab interference

Information Not Available

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