vecuronium (Rx)

Brand and Other Names:Norcuron
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 10mg
  • 20mg
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General Anesthesia

Adjunct to general anesthesia-induced muscle relaxation for endotracheal intubation, mechanical ventilation

Dose should be calculated based on ideal body weight

Injection

  • Load: 0.08-0.1 mg/kg IVP over 60 sec OR  
  • 0.04-0.06 mg/kg IVP if following succinylcholine, PLUS
  • Maintenance: 0.01-0.015 mg/kg IVP 20-45min post initial PRN

Continuous Infusion

  • Load: 0.001 mg/kg/min IV starting 20 min post bolus recovery
  • Maintenance: 0.0008-0.0012 mg/kg/min

Dosage Forms & Strengths

powder for injection

  • 10mg
  • 20mg
more...

General Anesthesia

Adjunct to general anesthesia-induce muscle relaxation for endotracheal intubation, mechanical ventilation

1-10 years old

  • 0.1 mg/kg IVP; repeat q1hour PRN; OR 
  • Continuous Infusion: 0.05-0.07 mg/kg/hour IV

Neonates; <28 days old (off-label)

  • Load: 0.1 mg/kg IV x1 dose
  • Maintenance: 0.03-0.15 mg/kg IV q1-2hours PRN

7 weeks-1 year old (off-label)

  • Load: 0.08-0.1 mg/kg IV x1 dose
  • Maintenance: 0.05-0.1 mg/kg IV q1hour PRN
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Interactions

Interaction Checker

and vecuronium

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            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

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            Warnings

            Black Box Warnings

            The drug should be administered only by adequately trained individuals familiar with its actions, characteristics, and hazards

            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

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            Pregnancy & Lactation

            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.

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            Pharmacology

            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

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            Administration

            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

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.