Vecuronium bromide

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Vecuronium bromide
Vecuronium bromide.svg
Clinical data
AHFS/Drugs.com Monograph
Pregnancy
category
  • US: C (Risk not ruled out)
Routes of
administration
Intravenous
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 100% (IV)
Metabolism liver 30%
Onset of action < 1 min[1]
Biological half-life 51–80 minutes (longer with renal failure)
Duration of action 15 - 30 min[2]
Excretion Fecal (40-75%) and kidney (30% as unchanged drug and metabolites)
Identifiers
CAS Number
PubChem CID
ChemSpider
UNII
ChEMBL
Chemical and physical data
Formula C34H57BrN2O4
Molar mass 637.73 g/mol
3D model (Jmol)
 NYesY (what is this?)  (verify)

Vecuronium bromide, sold under the brand name Norcuron among others, is a medication used as part of general anesthesia to provide skeletal muscle relaxation during surgery or mechanical ventilation. It is also used to help with endotracheal intubation; however, suxamethonium (succinylcholine) is generally preferred if this needs to be done quickly. It is given by injection into a vein. Effects are greatest at about 4 minutes and last for up to an hour.[1]

Side effects may include low blood pressure and prolonged paralysis.[3] Allergic reactions are rare.[4] It is unclear if use in pregnancy is safe for the baby. Vecuronium is in the neuromuscular-blocker family of medications and is of the non-depolarizing type. It works by blocking the action of acetylcholine on skeletal muscles.[1]

Vecuronium was approved for medical use in the United States in 1984.[1] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[5] Vecuronium is available as a generic medication.[1] In the United States it is less than 25 USD a dose.[2] The effects may be reversed with neostigmine and atropine.[1]

Clinical pharmacology[edit]

Vecuronium operates by competing for the cholinoceptors at the motor end plate thereby exerting its muscle-relaxing properties which are used adjunctively to general anesthesia. Under balanced anesthesia, the time to recovery to 25% of control (clinical duration) is approximately 25 to 40 minutes after injection and recovery is usually 95% complete approximately 45 to 65 minutes after injection of intubating dose. The neuromuscular blocking action of vecuronium is slightly enhanced in the presence of potent inhalation anesthetics. If vecuronium is first administered more than 5 minutes after the start of the inhalation of enflurane, isoflurane, or halothane, or when a steady state has been achieved, the intubating dose of vecuronium may be decreased by approximately 15%.

History[edit]

Vecuronium's structure is derived from the same aminosteroid structure as pancuronium, but it is missing the methyl group on the piperidine nitrogen that is attached to the 'A' ring, making it monoquaternary, like D-tubocurarine. It has the same configuration at all ten stereocentres as pancuronium, and is a single-isomer preparation.

Society and culture[edit]

It is commercially available as ampoules containing 4 or 10 mg of the drug in powder form which needs to be dissolved in distilled water prior to being given.

Non-medical use[edit]

Vecuronium bromide can be used as part of a drug cocktail that prisons in the United States use as a means to put a condemned prisoner to death. Vecuronium is used to paralyze the prisoner and stop his or her breathing, in conjunction with a sedative and potassium chloride to stop the prisoner's heart. Injections of vecuronium bromide without proper sedation allow the person to be fully awake but unable to move in response to pain.[6]

In 2001, Japanese nurse Daisuke Mori was reported to have murdered 10 patients using vecuronium bromide.[7] He was convicted of murder and was sentenced to life imprisonment.[8]

References[edit]

  1. ^ a b c d e f "Vecuronium Bromide". The American Society of Health-System Pharmacists. Retrieved 8 December 2016. 
  2. ^ a b Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 23. ISBN 9781284057560. 
  3. ^ "NORCURON 10mg - Summary of Product Characteristics (SPC) - (eMC)". www.medicines.org.uk. 4 August 2000. Retrieved 16 December 2016. 
  4. ^ WHO Model Formulary 2008 (PDF). World Health Organization. 2009. p. 431. ISBN 9789241547659. Retrieved 8 December 2016. 
  5. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016. 
  6. ^ "One Execution Botched, Oklahoma Delays the Next". New York Times. April 29, 2014. 
  7. ^ "Japanese nurse kills 10 patients, says wanted to trouble hospital". The Indian Express. 2001-01-10. Retrieved 2008-03-22. 
  8. ^ "Nurse gets life for patient slaying". The Japan Times Weekly. April 10, 2004. Retrieved October 26, 2011.