Vecuronium bromide
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| Clinical data | |
|---|---|
| AHFS/Drugs.com | Monograph |
| Routes of administration | Intravenous |
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| Pharmacokinetic data | |
| Bioavailability | 100% (IV) |
| Metabolism | liver 30% |
| Elimination half-life | 51–80 minutes (longer with renal failure) |
| Excretion | Fecal (40-75%) and renal (30% as unchanged drug and metabolites) |
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| CAS Number | |
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| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.051.549 |
| Chemical and physical data | |
| Formula | C34H57BrN2O4 |
| Molar mass | 637.73 g/mol g·mol−1 |
| 3D model (JSmol) | |
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Vecuronium bromide (Norcuron) is a muscle relaxant in the category of non-depolarizing blocking agents. Vecuronium bromide is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Although vecuronium bromide is often thought of as a muscle relaxant, it may be more accurate to classify it as a paralyzing agent. 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 administration to the patient.
It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system.[2]
Clinical pharmacology
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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%.
Non-medical use
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 bromide 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.[3]
In 2001, Japanese nurse Daisuke Mori was reported to have murdered 10 patients using vecuronium bromide.[4] He was convicted of murder and was sentenced to life imprisonment.[5]
History
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.
References
- ^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.
- ^ "19th WHO Model List of Essential Medicines (April 2015)" (PDF). WHO. April 2015. Retrieved May 10, 2015.
- ^ "One Execution Botched, Oklahoma Delays the Next". New York Times. April 29, 2014.
{{cite news}}: Italic or bold markup not allowed in:|publisher=(help) - ^ "Japanese nurse kills 10 patients, says wanted to trouble hospital". The Indian Express. 2001-01-10. Retrieved 2008-03-22.
- ^ "Nurse gets life for patient slaying". The Japan Times Weekly. April 10, 2004. Retrieved October 26, 2011.