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vecuronium (Norcuron)
Tradename: Norcuron.
Indications:
1) relaxation of skeletal muscles during surgical procedures under general anesthesia
2) increase pulmonary compliance during mechanical ventilation
3) status asthmaticus resistant to other therapy
4) neuromuscular blocking agent of choice in most critically ill patients WITH significant cardiac disease or hemodynamic instability
5) facilitate endotracheal intubation
Dosage:
1) ALWAYS use with sedative, i.e. lorazepam (Ativan)
2) should be used with analgesic if needed
3) start: 0.08-0.1 mg/kg (4-5 mg)
4) maintenance: 0.18-1.2 ug/kg/min (3 mg/hr)
5) titrate dose to patient's needs
Powder for injection: 10 mg. Phamacokinetics:
1) rapid onset of action (4 minutes)
2) onset & duration of action are dose-dependent
3) 1/2life is 30-90 minutes
4) duration 15-30 min
5) 5-10% metabolized to several compounds, some which are active
6) elimination
a) mainly in the feces via biliary elimination
b) drug & metabolites also elminated in the urine
7) 1/2life is prolonged in patients with hepatic or renal impairment
8) accumulation in critically ill patients
9) accumulation due to renal failure does not cause prolonged paralysis
Adverse effects:
1) uncommon (< 1%)
- rash, itching, tachycardia, flushing, edema, hypotension, circulatory collapse, bradycardia, hypersensitivity
2) other
- muscle weakness
- redness at the site of injection
- increased risk of DVT
- prolonged paralysis
- salivation
- exacerbation of adverse effects with hyperkalemia or hypokalemia
Toxicity:
- neostigmine, pyridostigmine, edrophonium (cholinesterase inhibitors) are used with atropine (muscarinic antagonist) to reverse neuromuscular blockade
Drug interactions:
1) aminoglycosides, tetracyclines, clindamycin, K+-depleting agents (loop diuretics, thiazides, amphotericin B, corticosteroids) in combination increase & prolong neuromuscular blockade
2) corticosteroids in combination prolong muscle weakness
3) neostigmine, pyridostigmine, edrophonium & other cholinesterase inhibitors are used with atropine to reverse neuromuscular blockade
4) magnesium sulfate
5) quinidine
6) verapamil
Mechanism of action:
1) non-depolarizing neuromuscular blocking agent
2) diminishes response to acetylcholine at the motor endplate
Interactions
drug interactions
General
neuromuscular blocker (paralyzing agent)
steroid
Properties
MISC-INFO: elimination route LIVER
KIDNEY
1/2life 30-90 MINUTES
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998 - not on National VA formulary
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998