VECURONIUM BROMIDE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VECURONIUM BROMIDE (VECURONIUM BROMIDE).
Competitive antagonist at nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine binding and muscle contraction.
| Metabolism | Primarily hepatic deacetylation via ester hydrolysis; minor renal excretion. Active metabolite 3-desacetylvecuronium has approximately 50% of parent potency. |
| Excretion | Primarily renal (40-60% unchanged in urine within 24 hours); biliary/fecal elimination accounts for <20%. Approximately 10-20% as 3-desacetylvecuronium (active metabolite) in urine. |
| Half-life | Terminal elimination half-life: 1.2-1.9 hours (65-115 minutes). Clinically, recovery from neuromuscular blockade is faster than with pancuronium; prolonged in renal and hepatic impairment. |
| Protein binding | Approximately 60-80% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | Vd: 0.24-0.45 L/kg. Represents moderate distribution, primarily into extracellular fluid; does not cross biological membranes readily. |
| Bioavailability | IV: 100% (not administered via other routes due to high ionization and rapid degradation in GI tract). |
| Onset of Action | IV: 2.5-3 minutes for intubating dose (0.08-0.1 mg/kg); maximal effect within 3-4 minutes. Faster onset with higher doses or when preceded by a defasciculating dose of a depolarizing agent. |
| Duration of Action | Clinical duration (time to 25% recovery of T1): 20-35 minutes after intubating dose. Maintenance doses every 12-15 minutes for surgical relaxation. Prolonged in hepatic impairment, renal failure, and with volatile anesthetics. |
| Molecular Weight | 637.76 |
IV bolus: 0.08-0.1 mg/kg for intubation; maintenance: 0.01-0.015 mg/kg every 12-15 minutes as needed or continuous infusion 0.05-0.1 mg/kg/hour.
| Dosage form | INJECTABLE |
| Renal impairment | GFR 10-50 mL/min: no adjustment; GFR <10 mL/min: use with caution, prolonged effect possible; consider extended dosing interval. |
| Liver impairment | Child-Pugh Class A: no adjustment; Child-Pugh Class B: reduced dose, monitor effect; Child-Pugh Class C: contraindicated due to prolonged recovery. |
| Pediatric use | Neonates: 0.03-0.1 mg/kg IV; Infants/Children: 0.08-0.1 mg/kg IV for intubation; maintenance: 0.01-0.015 mg/kg every 12-15 minutes as needed. |
| Geriatric use | Dose reduction recommended; initial dose 0.06-0.08 mg/kg; prolonged duration of action possible; monitor neuromuscular function closely. |
| 1st trimester | Category C: Fetal risk cannot be ruled out. Generally avoided unless essential for maternal surgery. |
| 2nd trimester | Category C: Use only if clearly needed. Crosses placenta minimally. |
| 3rd trimester | Category C: Use only if clearly needed. Risk of neonatal respiratory depression if given near delivery. |
Clinical note
Comprehensive clinical and safety monograph for VECURONIUM BROMIDE (VECURONIUM BROMIDE).
| Placental transfer | Minimal transfer; lipid-insoluble quaternary ammonium compound. Fetal levels are low relative to maternal doses. |
| Breastfeeding | Excretion into breast milk is minimal due to high molecular weight and low lipid solubility; unlikely to affect nursing infant. Compatible with breastfeeding. |
| Lactation Rating |
■ FDA Black Box Warning
Should be administered only by experienced clinicians familiar with neuromuscular blocking agents. Facilities for intubation, mechanical ventilation, and reversal agents (e.g., neostigmine) must be immediately available.
| Serious Effects |
Hypersensitivity to vecuronium or bromidesSevere myasthenia gravisNarrow-angle glaucoma (relative, but caution)
| Precautions | Risk of prolonged neuromuscular blockade, especially in hepatic/renal impairment. Monitor neuromuscular function with a nerve stimulator. Avoid in patients with known hypersensitivity. Use with caution in myasthenia gravis, electrolyte disturbances, acidosis, or dehydration. May cause histamine release (rarely). |
| Food/Dietary | No known food interactions with vecuronium. As it is administered intravenously during anesthesia, dietary restrictions are not applicable. However, patients should follow pre-operative fasting guidelines as recommended by their anesthesiologist. |
Loading safety data…
| L1 (Compatible) |
| Teratogenic Risk | Pregnancy Category C. Animal studies have shown an increased incidence of skeletal variations and delayed ossification at doses higher than human equivalent. No adequate human studies exist. Neuromuscular blocking agents cross the placenta minimally. Risk of fetal respiratory depression if administered near delivery. |
| Fetal Monitoring | Monitor maternal heart rate, blood pressure, oxygen saturation, and neuromuscular function with a peripheral nerve stimulator during administration. Fetal heart rate monitoring recommended when used during cesarean section. |
| Fertility Effects | No known direct effects on fertility in humans or animals. Use in assisted reproduction not studied. |
| Clinical Pearls | Vecuronium is an aminosteroid non-depolarizing neuromuscular blocker with intermediate duration (30-40 min). It has minimal histamine release and no vagolytic activity. Reversal is with neostigmine or sugammadex. Vecuronium is primarily hepatically eliminated, so its duration is prolonged in liver disease. It is more potent than pancuronium and does not cause autonomic side effects. Use cautiously in myasthenia gravis (resistance) or myasthenic syndrome (sensitivity). Dosing: 0.08-0.1 mg/kg for intubation. For continuous infusion, monitor train-of-four. |
| Patient Advice | Vecuronium is used as part of anesthesia to relax muscles during surgery or mechanical ventilation. · You will be fully unconscious and feel no pain while receiving this medication. · You will not be able to breathe on your own; a machine will breathe for you until the drug wears off. · The effects of vecuronium will be reversed after surgery with another medication. · Tell your doctor if you have a history of liver disease, kidney disease, or muscle disorders. · Do not take any other medications without consulting your anesthesiologist. |