Chemical formula: C₃₄H₅₇N₂O₄+ Molecular mass: 557.827 g/mol PubChem compound: 39765
Vecuronium interacts in the following cases:
The following drugs have been shown to influence the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents.
Halogenated volatile anaesthetics potentiate the neuromuscular block of vecuronium. The effect only becomes apparent with maintenance dosing. Reversal of the block with cholinesterase inhibitors could also be inhibited.
After intubation with suxamethonium.
Long-term concomitant use of corticosteroids and vecuronium in the ICU may result in prolonged duration of neuromuscular block or myopathy.
Other drugs:
Recurarisation has been reported after post-operative administration of:
Administration of other non-depolarising neuromuscular blocking agents in combination with vecuronium may produce attenuation or potentiation of the neuromuscular block, depending on the order of administration and the neuromuscular blocking agent used.
Vecuronium combined with lidocaine may result in a quicker onset of action of lidocaine.
The following drugs have been shown to influence the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents.
Decreased effect:
Suxamethonium given after the administration of vecuronium may produce potentiation or attenuation of the neuromuscular blocking effect of vecuronium.
Patients with burns are known to develop resistance to non-depolarising agents. It is recommended that the dose is titrated to response.
Because vecuronium is excreted in bile and in urine, vecuronium should be used with caution in patients with clinically significant hepatic and/or biliary diseases and/or renal failure. In these patient groups prolongation of action has been observed, especially when high doses of vecuronium (200 micrograms/kg bodyweight) were administered in patients with hepatic disease.
As with other neuromuscular blocking agents, vecuronium should be used with extreme caution in patients with neuromuscular disease or after poliomyelitis since the response to neuromuscular blocking agents may be considerably altered in these cases. The magnitude and direction of this alteration may vary widely. In patients with myasthenia gravis or the myasthenic (Eaton Lambert) syndrome, small doses of vecuronium may have profound effects and vecuronium should be titrated to the response.
In operations under hypothermia, the neuromuscular blocking effect of vecuronium is increased and the duration is prolonged.
Conditions which may increase the effects of vecuronium are: hypokalaemia (e.g. after severe vomiting, diarrhoea, and diuretic therapy), hypermagnesaemia, hypocalcaemia (after massive transfusions), hypoproteinaemia, dehydration, acidosis, hypercapnoea, cachexia. Severe electrolyte disturbances, altered blood pH or dehydration should therefore be corrected when possible.
There are insufficient data on the use of vecuronium during animal or human pregnancy to assess potential harm to the foetus. Vecuronium should be given to a pregnant woman only when the attending physician decides that the benefits outweigh the risks.
Reversal of vecuronium-induced neuromuscular block may be inhibited or unsatisfactory in patients receiving magnesium sulphate for toxaemia of pregnancy because magnesium salts enhance neuromuscular block. Therefore, in patients receiving magnesium sulphate, the dosage of vecuronium should be reduced and be carefully titrated to twitch response.
Studies with vecuronium, administered in doses up to 100 micrograms/kg, have shown its safety for use in caesarean section. In caesarean section the dose should not exceed 100 micrograms/kg.
In several clinical studies vecuronium did not affect Apgar score, foetal muscle tonus or cardiorespiratory adaptation. From umbilical cord blood sampling it is apparent that only very little placental transfer of vecuronium occurs which did not lead to the observation of any clinical adverse effect in the new-born.
It is unknown whether vecuronium bromide is excreted in human breast milk. The excretion of vecuronium bromide in milk has not been studied in animals. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with vecuronium bromide should be made taking into account the benefit of breast-feeding to the child and the benefit of vecuronium bromide therapy to the woman.
Animal studies do not indicate an effect on fertility.
Since vecuronium is used as an adjunct to general anaesthesia, the usual precautionary measures after a general anaesthesia should be taken for ambulatory patients.
Adverse drug reactions (ADRs) are rare (<1/1000). The most commonly occurring ADRs include changes in vital signs and prolonged neuromuscular block. The most frequently reported ADR during post-marketing surveillance is ‘anaphylactic and anaphylactoid reactions’ and associated symptoms (reporting frequency <1/100 000). See also the explanations below the list.
Adverse reactions are ranked under headings of frequency, the most frequent first, using the following convention: uncommon/rare (<1/100, >1/10,000), very rare (<1/10,000).
Very rare: Hypersensitivity, Anaphylactic reaction, Anaphylactoid reaction, Anaphylactic shock, Anaphylactoid shock
Very rare: Flaccid paralysis
Uncommon/rare: Tachycardia
Uncommon/rare: Hypotension
Very rare: Circulatory collapse and shock, Flushing
Very rare: Bronchospasm
Very rare: Angioneurotic edema, Urticaria, Rash, Erythematous rash
Very rare: Muscular weakness1, Steroid myopathy1
Uncommon/rare: Drug ineffective, Decreased drug effect/therapeutic response, Increased drug effect/therapeutic response
Very rare: Face oedema, Injection site pain, Injection site reaction
Uncommon/rare: Prolonged neuromuscular block, Delayed recovery from anaesthesia
Very rare: Airway complication of anaesthesia
MedDRA version 8.0
Frequencies are estimates derived from post-marketing surveillance reports and data from the general literature.
1 after long-term use in the ICU
The most frequent adverse reaction to non-depolarising blocking agents as a class consists of an extension of the drug’s pharmacological action beyond the time period needed. This may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiratory insufficiency or apnoea. A few cases of myopathy have been reported after vecuronium was used in the ICU in combination with corticosteroids.
Although very rare, severe anaphylactic reactions to neuromuscular blocking agents, including vecuronium, have been reported. Anaphylactic/anaphylactoid reactions usually comprise of several signs or symptoms e.g. bronchospasm, cardiovascular changes (e.g. hypotension, tachycardia, circulatory collapse – shock), and cutaneous changes (e.g. angioedema, urticaria). These reactions have, in some cases, been fatal. Due to the possible severity of these reactions, one should always assume they may occur and take the necessary precautions.
Since neuromuscular blocking agents are known to be capable of inducing histamine release both locally at the site of injection and systemically, the possible occurrence of itching and erythematous reactions at the site of injection and/or generalised histaminoid (anaphylactoid) reactions (see also under anaphylactic reactions above) should always be taken into consideration when administering these drugs.
Experimental studies with intradermal injection of vecuronium have demonstrated that this drug has only a weak capacity for inducing local histamine release. Controlled studies in man failed to demonstrate any significant rise in plasma histamine levels after intravenous administration of vecuronium. Nevertheless, such cases have rarely been reported during large scale use of vecuronium.
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