VECURONIUM BROMIDE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VECURONIUM BROMIDE (VECURONIUM BROMIDE).

How it works

Competitive antagonist at nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine binding and muscle contraction.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for VECURONIUM BROMIDE (VECURONIUM BROMIDE).

Breastfeeding	No data on excretion in human milk. M/P ratio unknown. Risk to infant unlikely due to poor oral bioavailability and rapid maternal clearance. Use caution in nursing mothers.
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.

Warnings & precautions

■ 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.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to vecuronium or other neuromuscular blocking agents; known history of anaphylactic reaction to vecuronium bromide.

Clinical Precautions

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).

Clinical Tips & Counseling

Drug interactions

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VECURONIUM BROMIDE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VECURONIUM BROMIDE (VECURONIUM BROMIDE).

How it works

Competitive antagonist at nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine binding and muscle contraction.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for VECURONIUM BROMIDE (VECURONIUM BROMIDE).

Breastfeeding	No data on excretion in human milk. M/P ratio unknown. Risk to infant unlikely due to poor oral bioavailability and rapid maternal clearance. Use caution in nursing mothers.
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.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to vecuronium or other neuromuscular blocking agents; known history of anaphylactic reaction to vecuronium bromide.