vecuronium
Brand: Norcuron
ISMP High Alert Prototype: succinylcholine
Drug Class: neuromuscular blocking agent (NMBA)
Drug Family: neuromuscular blocking agent
Subclass: non-depolarizing NMBA (aminosteroid)
Organ Systems: cnsmusculoskeletal
Mechanism of Action
Intermediate-duration non-depolarizing NMBA; competitive nicotinic antagonist at the NMJ. Minimal cardiovascular effects (no histamine release, no ganglionic blockade). Partially reversed by neostigmine and fully reversed by sugammadex.
nicotinic acetylcholine receptor at NMJ (competitive antagonist)
Indications
- facilitation of endotracheal intubation
- intraoperative skeletal muscle relaxation
- facilitation of mechanical ventilation in ICU
Contraindications
- hypersensitivity to vecuronium
Adverse Effects
Common
- residual neuromuscular blockade
Serious
- prolonged paralysis in liver/renal impairment
- anaphylaxis (rare)
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | protein binding ~30%; Vd ~0.27 L/kg |
| Metabolism | hepatic; active metabolite 3-desacetylvecuronium (50-70% potency of parent) |
| Excretion | biliary (~40-75%) and renal (25%) |
| Half-life | 65-75 minutes |
| Onset | 2-3 minutes at 0.1 mg/kg |
| Peak | 3-5 minutes |
| Duration | 25-40 minutes at 0.1 mg/kg |
| Protein Binding | 30% |
| Vd | 0.27 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| aminoglycosides | potentiate blockade | moderate |
| succinylcholine (priming) | prior succinylcholine enhances subsequent vecuronium effect | moderate |
Nursing Considerations
- Prolonged blockade occurs in hepatic impairment due to accumulation of active 3-desacetylvecuronium metabolite; monitor carefully in liver disease.
- Vecuronium can be reversed by neostigmine (with anticholinergic) or sugammadex depending on depth of blockade.
- Assess TOF before reversal; ensure respiratory muscle function (TOF ratio >0.9) before extubation.
- Dilute in compatible IV fluid; stable in NS, D5W, LR for 24 hours.
Clinical Pearls
- Vecuronium has minimal cardiovascular effects making it preferred in cardiac patients where tachycardia or histamine release are concerns.
- The 3-desacetylvecuronium active metabolite accumulates in renal and hepatic failure, causing prolonged blockade (ICU myopathy if combined with corticosteroids).
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
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