Vecuronium Bromide

Registered South African indications:

• Muscle relaxation

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients 

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Cardiovascular disease
• Oedema
• Neuromuscular disease
• Hypothermia
• Obesity
• Burns
• Hypokalaemia
• Hypermagnesaemia
• Hypocalcaemia
• Hypoproteinaemia
• Dehydration
• Acidosis
• Hypercapnoea
• Cachexia

Forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

• IV: 80-100μg/kg, as a bolus

Maintenance of muscle relaxation for surgical procedures

• IV: 30-50μg/kg, as a bolus, given when twitch height has recovered to 25% of control twitch height
• IV: 0.8-1.4μg/kg/min, as an infusion

Paed. forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

Between 0-4 months

• IV: Initial: 10-20μg/kg, as a bolus; Then 80-100μg/kg

Older than 5 months

• See adult dosage

Maintenance of muscle relaxation for surgical procedures

• See adult dosage

Pregnancy

• Caution
• Animal reproduction studies have not been done and there are no controlled data in human pregnancy. There have been reported cases for use in cesarean section

Breastfeeding

• Caution
• It is not known if vecuronium is present in breast milk

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended
  Initiate at lower end of dosage range; Titrate gradually as needed

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warning

Central Nervous System Disorders

• Flaccid paralysis
• Prolonged block 
• Delayed recovery from anaesthesia 

Cardiovascular Disorders

• Tachycardia
• Hypotension
• Circulatory shock
• Flushing

Respiratory Disorders

• Bronchospasm
• Airway compromise 

Musculoskeletal Disorders

• Muscular weakness
• Steroid myopathy

Skin and Subcutaneous Tissue Disorders

• Angioneurotic oedema
• Urticaria
• Rash
• Erythematous rash

Immune, Blood and Lympathic System Disorders

• Hypersensitivity
• Anaphylactic reaction
• Anaphylactoid reaction
• Anaphylactic shock
• Anaphylactoid shock

• Halogenated anaesthetics
• Cholinesterase inhibitors
• Suxamethonium chloride 
• Corticosteroids
• Aminoglycosides
• Lincosamide
• Polypeptide antibiotics
• Acylamino-penicillin antibiotics
• Diuretics
• Quinidine
• Magnesium salts
• Calcium channel blockers
• Lithium
• Cimetidine
• Lignocaine
• Phenytoin
• Carbamazepine
• Beta-blockers
• Calcium chloride
• Potassium chloride

None routine

Vecuronium bromide is a bisquaternary nitrogen compound that acts by competitively binding to nicotinic cholinergic receptors. The binding of vecuronium decreases the opportunity for acetylcholine to bind to the nicotinic receptor at the postjunctional membrane of the myoneural junction. As a result, depolarization is prevented, calcium ions are not released and muscle contraction does not occur.

Injection (per 2ml) 4mg

• Muscuron (Ranbaxy)
• Norcuron (Sanofi Aventis)