Vecuronium bromide injection
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Powder for solution for injection containing vecuronium bromide.
Drugs List
Therapeutic Indications
Uses
Neuromuscular blockade to facilitate intubation during surgery
An adjunct to general anaesthesia to facilitate tracheal intubation and skeletal muscle relaxation during surgery.
Dosage
Individual requirements vary and the recommended dosages are only a guide.
The anaesthetic method used, the expected duration of surgery, the concomitant medication used and the patient condition should be taken into account when determining the dose.
The use of an appropriate neuromuscular monitoring technique is recommended to monitor neuromuscular block and recovery.
Adults
Tracheal intubation
Loading dose
80micrograms/kg to 100micrograms/kg by intravenous injection.
Maintenance
20micrograms/kg to 30micrograms/kg by intravenous injection, to be given when twitch height has recovered to 25% of control twitch height.
Alternatively, 0.8micrograms/kg/minute to 1.4micrograms/kg/minute by continuous intravenous infusion can be used to maintain neuromuscular block. Monitoring of neuromuscular block is recommend as infusion rate requirements vary in individual patients.
Surgical procedures after intubation with suxamethonium
If suxamethonium is used for intubation, the administration of vecuronium bromide should be delayed until the patient has recovered from the neuromuscular block induced by suxamethonium.
Maintenance
30micrograms/kg to 50micrograms/kg.
Children
Children aged 12 to 18 years
Tracheal intubation
Loading dose
80micrograms/kg to 100micrograms/kg by intravenous injection.
Maintenance
20micrograms/kg to 30micrograms/kg by intravenous injection, to be given when twitch height has recovered to 25% of control twitch height.
Children aged 2 to 12 years
Dose requirements in children are higher than for adults and neonates. However, the same loading and maintenance doses by intravenous injection are usually sufficient. See Dosage; Adult.
The duration of action is shorter in children, maintenance doses are required more frequently.
Children aged 4 months to 2 years
The onset time of vecuronium bromide in patients in this age group is shorter in comparison to adults and older children. The use of high intubating doses in general are not required for early development of good intubating conditions.
The duration of action is shorter in children, maintenance doses are required more frequently. However, the dose requirements by intravenous injection are the same as adults. See Dosage; Adult.
Neonates from birth up to 4 months of age
Initial
As sensitivity of the neuromuscular junction may vary, an initial test dose of 10micrograms/kg to 20micrograms/kg is recommended. Followed by incremental doses until 90 to 95% depression of twitch response is achieved.
Maximum dose 100micrograms/kg.
Administration
To be administered by intravenous bolus injection or in adults only by a continuous intravenous infusion.
Contraindications
None known
Precautions and Warnings
Burns
Cachexia
Children under 4 months
Elderly
Hypoproteinaemia
Hypothermia
Obesity
Oedema
Biliary tract disorder
Breastfeeding
Cardiovascular disorder
Dehydration
Electrolyte imbalance
Hepatic impairment
Hypercapnia
Hypermagnesaemia
Hypocalcaemia
Hypokalaemia
Metabolic acidosis
Myasthenia gravis
Myasthenic Eaton-Lambert syndrome
Neuromuscular disorder
Poliomyelitis
Pregnancy
Renal impairment
Correct existing water and electrolyte disturbances before administration
Resuscitation facilities must be immediately available
To be administered by anaesthetist or a doctor trained in intensive care
Ventilatory support is mandatory until adequate respiration is restored
Monitor neuromuscular function
Neonates are particularly sensitive to non-depolarising NMBDs
May cause anaphylactic / anaphylactoid reactions
Burns patients may require dose modification
In obese patients dosing should be based on ideal weight
Driving or operating machinery not advisable following treatment
Pregnancy and Lactation
Pregnancy
Use vecuronium bromide with caution during pregnancy.
The manufacturer states that vecuronium bromide should only be used in pregnancy if the potential benefits outweigh the potential risks.
Briggs (2015) state that the use of vecuronium bromide during pregnancy has not been shown to result in any adverse effects on pregnancy rate, the foetus or the newborn. Due to the lack of animal studies using vecuronium bromide during pregnancy, a risk to the embryo during organogenesis cannot be excluded.
Studies with vecuronium bromide, administered in doses up to 100micrograms/kg, have shown its safety for use in caesarean section. In caesarean section the dose should not exceed 100micrograms/kg. In several clinical studies vecuronium bromide did not affect Apgar score, foetal muscle tonus or cardiorespiratory adaptation. Umbilical cord blood sampling shows that very little placental transfer of vecuronium bromide occurs, and no clinical adverse effects in the newborn were reported.
Lactation
Use vecuronium bromide with caution during breastfeeding.
The manufacturer recommends to decide whether to discontinue the use of vecuronium bromide or breastfeeding during treatment with vecuronium bromide. Taking into account the potential benefits and risks to the mother and infant.
It is unknown if vecuronium bromide is excreted into breast milk. No animal studies have been performed.
Briggs (2015) states that it is unlikely that clinically significant amounts of vecuronium bromide would be excreted into breast milk. Vecuronium bromide's relatively low molecular weight and it's low lipid solubility would inhibit its excretion into breast milk, therefore Briggs (2015) suggests a lack of risk to breastfed infants.
Side Effects
Anaphylactic reaction
Anaphylactic shock
Anaphylactoid reaction
Angioedema
Apnoea
Bronchospasm
Cardiovascular disturbances
Circulatory collapse
Erythema at injection site
Erythematous rash
Facial oedema
Flushing
Hypersensitivity reactions
Hypotension
Injection site reactions
Itching (injection site)
Local pain (injection site)
Muscle weakness
Myopathy
Paralysis
Rash
Respiratory insufficiency
Shock
Tachycardia
Urticaria
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: March 2019
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Vecuronium bromide 10mg powder for solution for injection. Kent Pharmaceuticals Ltd. Revised February 2016.
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