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(Brief summary, Uses, contraindication, precautions, pharmacodynamics, adverse effects, chemistry and formulation)
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Vecuronium is an steroidal intermediate acting non-depolarizing neuromuscular blocking agent  
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. -->==
==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
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===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===
===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===
Known hypersensitivity  
 
* Known hypersensitivity  


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


Dose requirement can be unpredictable in patients with renal failure  
* Prolonged duration of action in patients with cholestasis or cirrhosis
* Dose requirement can be unpredictable in patients with renal failure  
 
* Patients with myasthenia gravis/myathenic syndrome
* Amyotrophic lateral sclerosis
* Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous
* Familial periodic paralysis hyperkalemia
* Guillain-Barré syndrome
* Muscular dystrophy (Duchenne type)
* Myotonia including dystrophic, congenital,, and paramyotonia
* Patient may have resistance include:
** Burn injury
** Cerebral palsy
** Hemiplegia (on the affected side)
** Muscular denervation
** Severe chronic infection such as tetanus and botulism


==Pharmacology==
==Pharmacology==


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


Elimination via renal: 20-30%
====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====


3-desacetylvecuronium, 17-desacetylvecuronium and 3,17-desacetylvecuronium metabolites have neuromuscular blocking activity
* 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.
 
====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. -->====
====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====
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===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===
===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===
Duration of action of 40 minutes
 
* Duration of action of 40 minutes


==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==
==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==
2-desmethyl derivative of pancuronium
 
* 2-desmethyl derivative of pancuronium


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

Revision as of 08:41, 4 January 2023

Vecuronium
Vecuronium.svg
Clinical data
Drug class

Neuromuscular blocker

Routes of administration

Intravenous

Dosage
Standard
  • 0.1 mg/kg IV (Ideal body weight)
Rapid sequence
  • 0.15-0.2 mg/kg IV (Ideal body weight)
Maintenance (bolus)
  • 0.01-0.015 mg/kg IV q20-40m (Ideal body weight)
Maintenance (infusion)
  • 0.05-0.07 mg/kg/hr IV (Ideal body weight)
Indication 
Neuromuscular blockade
Route 
Intravenous

For rapid sequence, can give priming dose of 0.01 mg/kg three minutes before induction to reduce onset of paralysis to 75 to 90 seconds.

  1. Ramzy M, McAllister RK. Vecuronium. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493143/
  2. Smith CE, Kovach B, Polk JD, Hagen JF, Fallon WF Jr. Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium. Air Med J. 2002 Jan-Feb;21(1):26-32. doi: 10.1067/mmj.2002.121713. PMID: 11805764.
  3. Baumgarten RK, Carter CE, Reynolds WJ, Brown JL, DeVera HV. Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation. Can J Anaesth. 1988 Jan;35(1):5-11. doi: 10.1007/BF03010536. PMID: 2894903.
  4. Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
Pharmacodynamics
Mechanism of action

Nicotinic acetylcholine antagonism

Pharmacokinetics
Physical and chemical data
Article quality
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Unrated
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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

  • 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

Absolute contraindications

  • Known hypersensitivity

Precautions

  • Prolonged duration of action in patients with cholestasis or cirrhosis
  • Dose requirement can be unpredictable in patients with renal failure
  • Patients with myasthenia gravis/myathenic syndrome
  • Amyotrophic lateral sclerosis
  • Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous
  • Familial periodic paralysis hyperkalemia
  • Guillain-Barré syndrome
  • Muscular dystrophy (Duchenne type)
  • Myotonia including dystrophic, congenital,, and paramyotonia
  • Patient may have resistance include:
    • Burn injury
    • Cerebral palsy
    • Hemiplegia (on the affected side)
    • Muscular denervation
    • Severe chronic infection such as tetanus and botulism

Pharmacology

Pharmacodynamics

  • 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

  • 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

  • Anaphylactic reaction

Pharmacokinetics

  • Duration of action of 40 minutes

Chemistry and formulation

  • 2-desmethyl derivative of pancuronium

History

First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice

References

Top contributors: Cornel Chiu and Chris Rishel

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