Vecuronium

NORCURON

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Vecuronium ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Vecuronium ballicule

What it isIntermediate-acting muscle nicotinic-receptor antagonist; surgical paralysis.

Why this oneMinimal autonomic and histamine effects make it more hemodynamically neutral than pancuronium or atracurium.

What limits itHepatic impairment and an active metabolite can prolong blockade. Paralysis provides no sedation or analgesia.

Vecuronium molecular structure (skeletal formula) — Molecular structure: Vecuronium

FDA-approved for

neuromuscular blockade (surgery) (1984)

FDA label

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FDA dosing	Population	Start	Target	Max
Neuromuscular blockade (intubation and surgical relaxation, adjunct to anesthesia)	Adults	0.08–0.1 mg/kg IV bolus	Maintenance 0.01–0.015 mg/kg (first at ~25–40 min)

Renal Undefined

Hepatic Undefined

Maintenance doses generally required within 25–40 min of the initial dose.

Instructions

Intravenous use only; administered by/under supervision of clinicians experienced with neuromuscular blocking agents
Monitor muscle twitch response with peripheral nerve stimulation
Reduce initial dose with potent inhalation anesthetics (~15%) or prior succinylcholine

Available strengths

inj 10, 20 mg

Cautions

Prolonged/profound paralysis and respiratory insufficiency or apnea
Anaphylactic/anaphylactoid reactions (life-threatening, fatal)
Prolonged paralysis, muscle weakness, and atrophy with long-term ICU use

Adverse reactions

Prolonged skeletal muscle weakness/paralysis
Muscle atrophy (long-term use)
Hypersensitivity reactions (bronchospasm, hypotension, tachycardia, urticaria/erythema)

Pregnancy Undefined

Lactation Undefined

Cost

Vecuronium (NORCURON)

Strength		#/mo	generic $/unit	CostPlus
10 mg	inj	per unit		not offered
20 mg	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Vecuronium is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskNo sedation whatever — a recurring wrong-drug fatality

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityRespiratory paralysis requiring controlled ventilation

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