View source for Vecuronium

{{Infobox drug reference
| trade_names = Norcuron
| drug_class = Neuromuscular blocker
| drug_class_color = neuromuscular_blocker
| uses = Tracheal intubation, surgical relaxation, optimizing mechanical ventilation conditions, patients with ARDS
| contraindications = Known hypersensitivity
| routes = Intravenous
| dosage = 
| halflife_redistribution = 
| protein_binding = 
| clearance = 
| halflife_elimination = 
| adverse_effects = Anaphylactic reaction
| metabolism = Liver, bile, and renal
| duration = 40
| time_onset = 
| dosage_calculation = vecuronium
| mechanism = Nicotinic acetylcholine antagonism
| image_file = Vecuronium.svg
}}

Vecuronium is a steroidal intermediate acting non-depolarizing neuromuscular blocking agent used for tracheal intubation and surgical relaxation in patients. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit. 

==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==

* Optimizing tracheal intubation condition 
** Abduction of vocal cords
** Opening of mouth
** Reduction in coughing and gagging
* Provide surgical relaxation 
* Optimizing mechanical ventilation conditions
** Reduction in bucking/coughing
** Reduction in breath stacking

* Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering trans-pulmonary pressure reducing barotrauma.

==Contraindications<!-- List contraindications and precautions for use of the drug. -->==

===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===

* Known hypersensitivity 

===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===

* Prolonged duration of action in patients with cholestasis or cirrhosis 
* Use in patients with renal failure 

==Pharmacology==

===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===

* Primarily eliminated via hepatic metabolism: 30-40%
* Elimination via bile: 40% 
* Elimination via renal: 20-30%
* 3-desacetylvecuronium, 17-desacetylvecuronium and 3,17-desacetylvecuronium metabolites have neuromuscular blocking activity 

====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====

* Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.

====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====

* Anaphylactic reaction
*Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm
*Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
*Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.
*Incomplete reversal of neuromuscular blocking agent leading to respiratory depression

===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===

* Duration of action after 1 x ED<sub>95</sub> is 40 minutes<ref name=":0">{{Citation|last=Lien|first=Cynthia A.|title=Neuromuscular Blockers and Reversal Drugs|date=2013|url=http://dx.doi.org/10.1016/b978-1-4377-1679-5.00019-3|work=Pharmacology and Physiology for Anesthesia|pages=325–348|publisher=Elsevier|access-date=2023-01-05|last2=Eikermann|first2=Matthias}}</ref>

==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==

* 2-desmethyl derivative of pancuronium<ref name=":0" />
*Supplied as crystalline particles that may be reconstituted with IV fluid<ref name=":1">{{Cite book|last=Nina.|first=Gupta, Anita. Singh-Radcliff,|url=http://worldcat.org/oclc/940638246|title=Pharmacology in anesthesia practice|date=2013|publisher=Oxford University Press|isbn=978-0-19-978267-3|oclc=940638246}}</ref>

==History<!-- Describe the historical development of the drug. -->==

* First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice<ref name=":0" />

==References==
Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", ''Pharmacology and Physiology for Anesthesia'', Elsevier, pp.&nbsp;325–348, retrieved 2023-01-05<ref name=":0" />

Anita Gupta, Nina Singh-Radcliff. ''Pharmacology in Anesthesia Practice''. Oxford University Press; 2013. Accessed January 5, 2023. <nowiki>https://search-ebscohost-com.laneproxy.stanford.edu/login.aspx?direct=true&db=nlebk&AN=603930&site=ehost-live</nowiki><ref name=":1" />

[[Category:Drug reference]]
[[Category:Neuromuscular blockers]]
[[Category:Nondepolarizing neuromuscular blockers]]