Vecuronium is a non-depolarizing, intermediate-acting neuromuscular blocking agent (NMBA) used to induce skeletal muscle relaxation. It is given intravenously alongside general anesthesia to assist with endotracheal intubation and to maintain muscle relaxation during surgery or mechanical ventilation. Vecuronium relaxes muscles by blocking the signals between nerves and muscles. It is given before general anesthesia to help prepare you for surgery. It helps keep your body still during the procedure.
BRAND NAMES
Norcuron-powder for injection(10mg,20mg)
It is given 20 to 45 minutes after the initial dose and every 12 to 15 minutes as needed.
MECHANISM OF ACTION
Vecuronium is a non-depolarizing neuromuscular blocking agent that works by competitively blocking nicotinic acetylcholine receptors at the neuromuscular junction, which prevents muscle contraction. This causes temporary skeletal muscle paralysis, and is typically used as an adjunct to general anesthesia to facilitate endotracheal intubation and promote surgical muscle relaxation.
PHARMACOKINETICS
Absorption
Vecuronium has poor absorption and is not administered orally. The drug is administered intravenously (IV), which makes absorption effectively complete, as it is delivered directly into the bloodstream.
Distribution
The steady-state volume of distribution is estimated to be about 300 to 400 mL/kg.
Metabolism
Vecuronium is primarily metabolized by the liver through deacetylation, resulting in active metabolites, particularly 3-desacetylvecuronium. Both the parent compound and its metabolites are eliminated through a combination of biliary and renal excretion, with the liver playing the major role.
Excretion
Approximately 20–30% of vecuronium’s total elimination is through renal excretion. About 40–50% of a dose is excreted into the bile, which is then eliminated with feces.
PHARMACODYNAMICS
Vecuronium is an intermediate-acting, non-depolarizing neuromuscular blocking agent that works by competitively binding to nicotinic cholinergic receptors at the motor end plate. This action prevents acetylcholine from causing muscle depolarization, leading to dose-dependent skeletal muscle relaxation and flaccid paralysis.
ADMINISTRATION
Vecuronium is a powerful, non-depolarizing neuromuscular blocking agent that must only be administered intravenously by trained clinicians. It causes temporary skeletal muscle paralysis and requires mechanical ventilation to support the patient's breathing. Before administering vecuronium, several critical steps must be taken to ensure patient safety and optimal outcomes.
DOSAGE AND STRENGTH
Vecuronium is available as a lyophilized powder for intravenous administration, usually in 10 mg or 20 mg strengths.
DRUG INTERACTIONS
Vecuronium's neuromuscular blocking effect can be enhanced by several drugs, including volatile inhalational anesthetics, other neuromuscular blockers, and high doses of certain parenteral antibiotics. Its effect can also be intensified by magnesium salts and certain cardiac medications like quinidine, amiodarone, and some calcium channel blockers. Due to its acidic pH, vecuronium is chemically incompatible with alkaline solutions like thiopental and should not be mixed in the same syringe. The effects of vecuronium may also be affected by imbalances in electrolytes and acid-base levels.
FOOD INTERACTIONS
Vecuronium is a muscle relaxant administered intravenously in a clinical setting, primarily during surgery, so there are no known direct interactions with food. As the drug bypasses the digestive system, dietary intake does not affect its action. However, other substances, such as alcohol and various medications like certain antibiotics and anesthetics, can interact with vecuronium. Additionally, a patient's underlying health conditions, particularly liver or kidney disease, can alter how the body processes the medication. All factors affecting the drug are managed by the healthcare team overseeing its use.
CONTRAINDICATIONS
The main contraindication for vecuronium is a known allergy to the drug or to the bromide ion. Since it is a potent paralytic, it is also absolutely contraindicated in situations where there is no access to adequate ventilatory support.
SIDE EFFECTS
Prolonged paralysis and muscle weakness.
Respiratory depression and apnea.
Anaphylaxis.
Cardiovascular effects.
Increased intracranial pressure.
Swelling at the injection site.
Skin rash, itching, or redness.
Edema.
Dizziness.
OVER DOSE
The primary danger of a vecuronium overdose is the extended paralysis of the skeletal muscles, including those responsible for breathing.
Prolonged muscle paralysis.
Respiratory depression or apnea.
Low blood pressure.
Slow heart rate.
Cardiovascular collapse.
TOXICITY
Vecuronium toxicity is an overdose or excessive effect of the neuromuscular blocker, leading to prolonged and profound muscle paralysis, respiratory failure, and potential cardiovascular collapse. The risk of toxicity is highest in individuals with impaired liver or kidney function, as these organs are responsible for clearing vecuronium and its active metabolites from the body.
