vecuronium bromide: clinical use

Prescribing considerations

• Restrict administration to experienced clinicians with immediate facilities for airway management, ventilation and reversal of neuromuscular block.
• Ensure adequate anaesthesia, analgesia and sedation because vecuronium causes paralysis without unconsciousness or pain relief.
• Consider altered or prolonged response in older people and in hepatic, biliary or renal impairment, cardiovascular disease, oedema, hypothermia and obesity.
• Responses may be profound or unpredictable in myasthenia gravis, Lambert–Eaton syndrome, other neuromuscular disease or previous poliomyelitis; burns may cause resistance.
• Correct significant electrolyte disturbance, altered blood pH and dehydration where possible.
• Review previous hypersensitivity to any neuromuscular blocker because cross-sensitivity is reported.

Contraindications and cautions

• Hypersensitivity to vecuronium bromide, bromide ions or any listed excipient

Monitoring

• Use quantitative or otherwise appropriate neuromuscular monitoring during block and recovery.
• Continuously monitor ventilation, oxygenation and cardiovascular observations.
• Do not extubate until recovery from neuromuscular block is sufficient; consider interactions and clinical factors that increase residual blockade.
• During prolonged intensive-care use, monitor for persistent paralysis, weakness and corticosteroid-associated myopathy.

Clinical pharmacology

Vecuronium bromide is an aminosteroid, competitive antagonist of acetylcholine at nicotinic receptors on the motor end plate. Biliary excretion is the principal elimination route, with additional urinary elimination; hepatic, biliary or renal dysfunction may prolong its action.

Formulation and product differences

• The selected product is a white lyophilised powder for intravenous injection or infusion after reconstitution.
• Excipients are citric acid anhydrous, disodium hydrogen orthophosphate anhydrous and mannitol.
• The reconstituted solution should be clear and particle-free; only documented compatible diluents and infusion fluids should be used.
• Chemical stability after reconstitution is documented, but microbiological considerations generally favour immediate use unless preparation occurred under validated aseptic conditions.

Injection

Route: Parenteral

Strengths: 10 mg