vecuronium (Norcuron)
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Introduction
Tradename: Norcuron.
Indications
- relaxation of skeletal muscles during surgical procedures under general anesthesia
- increase pulmonary compliance during mechanical ventilation
- status asthmaticus resistant to other therapy
- neuromuscular blocking agent of choice in most critically ill patients WITH significant cardiac disease or hemodynamic instability
- facilitate endotracheal intubation
Dosage
- ALWAYS use with sedative, i.e. lorazepam (Ativan)
- should be used with analgesic if needed
- start: 0.08-0.1 mg/kg (4-5 mg)
- maintenance: 0.18-1.2 ug/kg/min (3 mg/hr)
- titrate dose to patient's needs
Powder for injection: 10 mg. Phamacokinetics:
- rapid onset of action (4 minutes)
- onset & duration of action are dose-dependent
- 1/2life is 30-90 minutes
- duration 15-30 min
- 5-10% metabolized to several compounds, some which are active
- elimination
- mainly in the feces via biliary elimination
- drug & metabolites also elminated in the urine
- 1/2life is prolonged in patients with hepatic or renal impairment
- accumulation in critically ill patients
- accumulation due to renal failure does not cause prolonged paralysis
Adverse effects
- uncommon (< 1%)
- 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
- aminoglycosides, tetracyclines, clindamycin, K+-depleting agents (loop diuretics, thiazides, amphotericin B, corticosteroids) in combination increase & prolong neuromuscular blockade
- corticosteroids in combination prolong muscle weakness
- neostigmine, pyridostigmine, edrophonium & other cholinesterase inhibitors are used with atropine to reverse neuromuscular blockade
- magnesium sulfate
- quinidine
- verapamil
Mechanism of action
- non-depolarizing neuromuscular blocking agent
- diminishes response to acetylcholine at the motor endplate
More general terms
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