vecuronium (Rx)

Frequency Not Defined

Skeletal muscle weakness or paralysis

Respiratory insufficiency or apnea

Hypersensitivity reactions associated with histamine release (e.g., bronchospasm, flushing, erythema, acute urticaria, hypotension, tachycardia)

Itching

Myositis ossificans (prolonged use)

Acute quadriplegic myopathy syndrome (prolonged use)

Less cardiovascular effects than pancuronium or atracurium

Contraindications

Hypersensitivity

Lack of ventilatory support

Neuromuscular disease

Cautions

Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent

Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken; neuromuscular cross-sensitivity with other nuromuscular blocking agents possible

Some patients may experience prolonged recovery (paralysis) of neuromuscular function

Adequate ventilatory support mandatory, may experience resistance with >25% TBSA burns, may experience increased sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)

CAUTION: Hepatobiliary obstruction, renal dysfunction will significantly prolong duration of action

Pregnancy Category: C

Lactation: Not known if excreted in breast milk; effect on nursing infant not known; used during pregnancy only when clearly needed

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist

Pharmacokinetics

Half-life: 3.3-9 min (distribution phase); 31-80 min (terminal phase); increased in hepatobiliary disease

Clearance: 2.9-6.4 mL/min/kg (normal renal function); 2.5-4.5 mL/min/kg (renal dysfunction); 0.97-2.7 mL/min/kg (hepatic dysfunction)

Vd: 50-120 mL/kg (central compartment, Vc); 179-400 mL/kg (steady-state, Vss)

Metabolism: Not been fully characterized; aqueous solution in vitro has shown spontaneous deacetylation at the 3a- &/or 17ß-positions to form hydroxy derivatives

Onset: 3-5 min

Duration: 20-35 min

Protein Bound: 60-90%

Excretion: 30% excreted unchanged in urine, 45% excreted unchanged in bile/feces

Less histamine release than pancuroniun or atracurium (and less effect on HR & MAP)

Little effect on intraocular/intracranial pressure

IV Incompatibilities

Y-site: ampho B chol SO4, diazepam, etomidate, furosemide, thiopental

IV Compatibilities

Solution: NS, D5W, D5/NS, LR

Additive: ciprofloxacin

Y-site: aminophylline, amiodarone, cefazolin, cefuroxime, cimetidine, clarithromycin, diltiazem, dobutamine, dopamine, epinephrine, esmolol, fenoldopam, fentanyl, fluconazole, gatifloxacin, gentamicin, heparin, Hextend, hydrocortisone, hydromorphone, isoproterenol, labetalol, linezolid, lorazepam, midazolam, milrinone, morphine, nicardipine, nitroglycerin, norepinephrine, propofol, ranitidine, Na nitroprusside, trimethoprim/sulfamethoxazole, vancomycin

IV Preparation

Rapid direct injection: dilute vial to max of 2 mg/mL

Infusion: dilute vial to max of 1 mg/mL

Solution:

• Rapid direct injection: dilute vial to max of 2 mg/mL
• Infusion: dilute vial to max of 1 mg/mL

IV Administration

Give either as a rapid direct injection or as an infusion

Storage

Store at room temp

Do not mix with alkaline drugs