Vecuronium Bromide

• Facilitation of Endotracheal Intubation: Used as an adjunct to general anesthesia to enable smooth intubation.
• Skeletal Muscle Relaxation During Surgery: Provides muscle relaxation during surgical procedures under general anesthesia to improve surgical conditions.
• Mechanical Ventilation: Used in intensive care units for patients requiring prolonged mechanical ventilation to facilitate ventilation and reduce oxygen consumption.
• Adjunct in Electroconvulsive Therapy (ECT): Prevents musculoskeletal injury by inducing muscle relaxation during treatment.
• Off-label Uses: Occasionally used for diagnostic procedures requiring muscle paralysis.

• Route: Intravenous injection or continuous IV infusion only.
• Adults:
• Initial dose for intubation: 0.08–0.1 mg/kg IV.
• Maintenance dose: 0.01–0.015 mg/kg IV every 25–40 minutes or continuous infusion at 0.8–1.2 mcg/kg/min.
• Pediatrics:
• Initial intubation dose: 0.1 mg/kg IV; maintenance doses adjusted by clinical response.
• Elderly:
• Dose reduction may be required due to decreased clearance.
• Patients with Renal or Hepatic Impairment:
• Dose adjustments necessary; prolonged drug effect expected.
• Administration Notes:
• Only administered after induction of anesthesia.
• Not for intramuscular use.
• Close monitoring of neuromuscular function is essential.

Vecuronium bromide is a non-depolarizing neuromuscular blocking agent that competitively inhibits acetylcholine at nicotinic receptors located on the motor endplate of skeletal muscle. By preventing acetylcholine binding, it blocks depolarization of the muscle membrane, thereby inhibiting muscle contraction and causing skeletal muscle relaxation. This neuromuscular blockade facilitates endotracheal intubation and provides muscle relaxation during surgery and mechanical ventilation.

• Absorption: Immediate and complete bioavailability via intravenous administration.
• Distribution: Rapidly distributes into extracellular fluid; volume of distribution approximately 0.22 L/kg.
• Metabolism: Partially metabolized by the liver to an active metabolite (3-desacetyl vecuronium) which has approximately 80% of the parent drug’s potency.
• Elimination: Eliminated primarily via hepatic metabolism and biliary excretion; renal excretion plays a secondary role.
• Half-life: Approximately 65 to 80 minutes, prolonged in hepatic and renal impairment.

• Pregnancy: FDA category C — animal studies have not shown teratogenicity but human data are insufficient. Use only if benefits outweigh risks.
• Lactation: It is unknown whether vecuronium is excreted in human breast milk; caution is advised and breastfeeding during treatment is generally not recommended.

• Neuromuscular blocking agent; non-depolarizing skeletal muscle relaxant.

• Known hypersensitivity to vecuronium bromide or any component of the formulation.
• Myasthenia gravis or other neuromuscular diseases (relative contraindication due to increased sensitivity).
• Severe hepatic impairment affecting drug metabolism.
• Conditions predisposing to electrolyte imbalances that may exacerbate neuromuscular blockade.

• Use caution in patients with neuromuscular diseases, hepatic or renal impairment.
• Monitor neuromuscular function to avoid prolonged paralysis.
• Respiratory support and resuscitation equipment must be immediately available, as paralysis includes respiratory muscles.
• Potential for histamine release, which may cause hypotension, flushing, or bronchospasm.
• Prolonged paralysis may occur with repeated dosing or in organ dysfunction.

• Common: Weakness, prolonged muscle paralysis, mild hypotension, flushing.
• Cardiovascular: Rare occurrences of bradycardia or tachycardia.
• Respiratory: Respiratory depression due to muscle paralysis.
• Allergic reactions: Rare anaphylaxis or histamine-mediated symptoms such as rash or bronchospasm.
• Neuromuscular: Residual or prolonged paralysis, especially in susceptible populations.

• Enhanced neuromuscular blockade with inhalational anesthetics (e.g., halothane, isoflurane).
• Potentiated effects when used with aminoglycosides, lithium, corticosteroids, magnesium salts.
• Chronic use of phenytoin or carbamazepine may reduce drug effectiveness.
• Additive effects with other neuromuscular blockers.

• Increased emphasis on neuromuscular monitoring during anesthesia to minimize risk of residual paralysis.
• Dose adjustment guidelines updated for hepatic and renal impairment patients.
• Reinforced warnings about prolonged paralysis risks and need for respiratory monitoring.

• Store at controlled room temperature between 20°C to 25°C (68°F to 77°F).
• Protect from light and moisture.
• Do not freeze.
• Use reconstituted or diluted solutions promptly as per manufacturer instructions.