Intravenous Facilitate endotracheal intubation, Muscle relaxant in general anaesthesia
Adult: Initially, 80-100 mcg/kg via IV inj. For surgical procedures after intubation with suxamethonium, an initial dose of 30-50 mcg/kg via IV inj may be given. If suxamethonium is used for intubation, delay vecuronium bromide administration until the patient has recovered from the neuromuscular block caused by suxamethonium. Maintenance dose: 20-30 mcg/kg via IV inj adjusted according to response. Alternative dosing recommendation: Initially, 80-100 mcg/kg via IV inj, followed by a maintenance dose of 0.8-1.4 mcg/kg/min via continuous IV infusion adjusted according to response. Max dose in caesarean section: 100 mcg/kg. Individualise and adjust the dose based on the procedure, anaesthetic methods used, concurrent drugs given and the patient's clinical response. Dosage recommendations may vary between countries or local guidelines (refer to specific local protocols). Elderly: Initiate at the lower end of the dosage range and titrate slowly. Child: ≤4 months An initial 10-20 mcg/kg test dose may be given, followed by incremental doses adjusted according to response. Maintenance doses may be required less frequently since the duration of action and recovery time is longer in infants. 5 months to 1 year Initially, 80-100 mcg/kg, then 20-30 mcg/kg maintenance doses. Use of high initial doses for intubation may not be required since the onset time is considerably shorter compared to children and adults; maintenance doses may also be required less frequently since the duration of action and recovery time is longer in infants. 2-10 years Initially, 80-100 mcg/kg, then 20-30 mcg/kg maintenance doses. More frequent maintenance doses may be required since the duration of action is shorter in children. >10-17 years Same as adult dose. All doses are given via IV inj. Individualise and adjust the dose based on the procedure, anaesthetic methods used, concurrent drugs given and the patient's clinical response. Dosage recommendations and age range of use may vary between countries or local guidelines (refer to specific local protocols).
Special Patient Group
Obese patients: Calculate dose using the ideal body weight, then titrate based on clinical effect.
Reconstitution
Powder for solution for IV inj: Reconstitute each vial with an appropriate amount of compatible solution (e.g. sterile water for inj, dextrose 5% in water, NaCl 0.9% solution, Lactated Ringer's solution, bacteriostatic water for inj) to make a concentration of 1 mg/mL. Do not use bacteriostatic water for inj for neonates. IV infusion: Further dilute the reconstituted solution with compatible solution (e.g. dextrose 5% in water, NaCl 0.9% solution) to make a final concentration of 0.1-0.2 mg/mL. Recommendations for reconstitution, dilution and concentration for different age groups may vary among individual products and between countries (refer to specific product guidelines).
Incompatibility
Incompatible with furosemide and alkaline solutions (e.g. thiopental).
Contraindications
Hypersensitivity.
Special Precautions
Patient with previous anaphylactic reaction to other neuromuscular blockers; biliary tract disease, burn injury; conditions that may antagonise neuromuscular blockade (e.g. respiratory alkalosis, hypercalcaemia, demyelinating lesions, peripheral neuropathies, denervation, muscle trauma); conditions associated with prolonged circulation time (e.g. CV disease, oedema); conditions that may potentiate neuromuscular blockade (e.g. neuromuscular disease, poliomyelitis, myasthenia gravis, Eaton-Lambert syndrome, electrolyte disturbances [e.g. hypokalaemia, hypermagnesaemia, hypocalcaemia], hypoproteinaemia, hypothermia, dehydration, metabolic or respiratory acidosis, hypercapnoea, cachexia). Obese and immobilised patients. Renal and hepatic impairment. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Residual neuromuscular blockade; prolonged paralysis or skeletal muscle weakness (particularly for long-term use in ICU patients); myopathy (long-term use in combination with corticosteroids in ICU patients). Cardiac disorders: Tachycardia. General disorders and administration site conditions: Inj site pain or reaction. Respiratory, thoracic and mediastinal disorders: Bronchospasm. Skin and subcutaneous tissue disorders: Rash, urticaria. Vascular disorders: Hypotension. Potentially Fatal: Severe anaphylactic reactions.
Screen for previous hypersensitivity reactions to other neuromuscular blocking agents whenever possible. Monitor vital signs (e.g. blood pressure, heart rate, respiratory rate) and the degree of muscle paralysis (e.g. presence of spontaneous movement, ventilator asynchrony, peripheral nerve stimulator). Assess for signs and symptoms of prolonged paralysis and generalised myopathy, particularly in the ICU setting.
Management: Symptomatic and supportive treatment. Maintain patent airway and manual or mechanical ventilation until complete recovery of normal respiration. May administer sugammadex in adult patients to reverse profound and deep block. Consider giving pyridostigmine, neostigmine, or edrophonium in combination with atropine or glycopyrrolate to antagonise the skeletal muscle effects of vecuronium bromide. Use a peripheral nerve stimulator to monitor restoration of twitch height. Continuously provide ventilation support until the patient has resumed control of respiration.
Drug Interactions
Increased neuromuscular blocking effect with volatile inhalational anaesthetics (e.g. halothane, enflurane, isoflurane), aminoglycosides, lincosamides, polypeptide antibiotics, acylaminopenicillin antibiotics, diuretics, quinidine, calcium channel blockers, magnesium salts, lidocaine, lithium salts, cimetidine, and acute administration of phenytoin or β-blockers. Increased risk of myopathy and prolonged duration of neuromuscular block with corticosteroids (long-term use). Decreased neuromuscular blocking effect with prior chronic administration of phenytoin or carbamazepine, calcium chloride or potassium chloride. Concurrent use with lidocaine may result in quicker lidocaine onset of action. Concomitant use with other non-depolarising neuromuscular blockers or suxamethonium may potentiate or attenuate the neuromuscular blocking effects of vecuronium bromide.
Action
Description: Mechanism of Action: Vecuronium bromide is an aminosteroidal intermediate-acting non-depolarising neuromuscular blocker. It competitively inhibits the binding of acetylcholine to the nicotinic receptors on the motor endplate, thereby blocking depolarisation. Onset: Within 2-4 minutes (good intubation conditions); within 3-5 minutes (Max neuromuscular blockade). Duration: Approx 20-30 minutes. Pharmacokinetics: Distribution: Volume of distribution: 0.3-0.4 L/kg. Plasma protein binding: 60-80%. Metabolism: Partially metabolised into the active metabolite, 3-desacetyl vecuronium (has half the activity of vecuronium bromide). Excretion: Mainly in the faeces (35-50%); urine (15-50% as unchanged drug and metabolites). Elimination half-life: 65-75 minutes.
Chemical Structure
Vecuronium bromide Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 39764, Vecuronium Bromide. https://pubchem.ncbi.nlm.nih.gov/compound/Vecuronium-Bromide. Accessed Nov. 25, 2025.
Storage
Intact vial: Store between 20-25°C. Protect from light. Reconstituted vial with compatible solutions (except bacteriostatic water for inj): May be stored between 2-8°C for up to 24 hours. Storage and stability recommendations may vary among individual products or between countries (refer to specific product guidelines).
M03AC03 - vecuronium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
References
Brayfield A, Cadart C (eds). Vecuronium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/09/2025.Joint Formulary Committee. Vecuronium Bromide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/09/2025.Paediatric Formulary Committee. Vecuronium Bromide. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 01/09/2025.Vecuronium Bromide 10 mg Powder for Solution for Injection/Infusion (Neon Healthcare Limited). MHRA. https://products.mhra.gov.uk. Accessed 01/09/2025.Vecuronium Bromide Injection, Powder, for Solution (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/09/2025.Vecuronium Bromide. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 01/09/2025.Vecuronium. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 01/09/2025.Vecuronium. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 01/09/2025.Vecuronium. UpToDate Lexidrug, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 01/09/2025.Viatris Ltd. Vecure 10 mg Powder for Injection data sheet 29 July 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 01/09/2025.
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