Intravenous Facilitate endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 100 mcg/kg by inj. Maintenance: 20-40 mcg/kg by inj or as continuous infusion at 0.8-1.4 mcg/kg/min. Surgical procedures after intubation with suxamethonium: 40-60 mcg/kg. Surgery under halothane and neuroleptic anaesthesia: Initially, 150-400 mcg/kg. Child: >7 weeks to <1 year Same with adult but use of high doses is not required and requirement of maintenance dose is less frequent; 2-10 years Same initial and maintenance doses as for adults, but maintenance doses are required more frequently.
Special Patient Group
Obese patients (≥130% of ideal body wt): Reduce dose, taking into account an ideal body wt.
Reconstitution
Add 10 mL or 20 mL of bacteriostatic water for inj to a vial containing 10 mg or 20 mg of the drug, respectively, to provide a soln containing 1 mg/mL. Further dilute to the desired concentration (usually, 0.1-0.2 mg/mL) to be used for IV infusion.
Incompatibility
Furosemide, alkaline soln (e.g. thiopental).
Special Precautions
Patient w/ CV disease, oedema, neuromuscular disease, previous poliomyelitis, burn injury, severe electrolyte disturbances, altered blood pH, dehydration; obese patient. Hepatic and renal impairment. Childn. Pregnancy and lactation.
Symptoms: Skeletal muscle weakness, decreased resp reserve, low tidal vol, apnoea. Management: Maintain a patent airway w/ manual or mechanical ventilation. May administer pyridostigmine, neostigmine or edrophonium in conjunction w/ atropine or glycopyrrolate to antagonise the muscle relaxant effect.
Drug Interactions
Increased effect w/ halogenated volatile anaesth (e.g. enflurane, isoflurane, halothane), certain antibiotics (e.g. aminoglycosides, lincosamide and polypeptide antibiotics, acylamino-penicillin antibiotics), diuretics, quinidine, Mg and lithium salts, Ca channel blockers, cimetidine, lidocaine and acute admin of phenytoin or β-blockers. Decreased effect w/ phenytoin and carbamazepine (chronic use), Ca and K salts.
Action
Description: Vecuronium competes w/ acetylcholine for cholinergic receptor sites, binding w/ nicotinic receptor at the motor end-plate, resulting to neuromuscular blockade. Onset: Good intubation conditions: W/in 2.5-3 min. Max neuromuscular blockade: W/in 3-5 min. Duration: Under balanced anaesth (time to recovery to 25% of control): 25-40 min; recovery 95% complete, approx 45-65 min after inj of intubating dose. Pharmacokinetics: Distribution: Rapidly distributed into extracellular space. Volume of distribution: 0.3-0.4 L/kg. Plasma protein binding: 60-80%. Metabolism: Undergoes partial hepatic metabolism via spontaneous deacetylation to form the active metabolite 3-desacetyl vecuronium. Excretion: Mainly via bile (as unchanged drug and metabolites), some in urine. Plasma elimination half-life: Approx 30-80 min.
Chemical Structure
Vecuronium bromide Source: National Center for Biotechnology Information. PubChem Database. Vecuronium bromide, CID=39764, https://pubchem.ncbi.nlm.nih.gov/compound/Vecuronium-bromide (accessed on Jan. 23, 2020)
M03AC03 - vecuronium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
References
Anon. Vecuronium Bromide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/08/2015.Buckingham R (ed). Vecuronium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/08/2015.McEvoy GK, Snow EK, Miller J et al (eds). Vecuronium Bromide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 05/08/2015.Vecuronium Bromide Injection, Lyophilized Powder for Solution (Mylan Institutional LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/08/2015.
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