DRUGS & SUPPLEMENTS
Vecuronium Bromide uses
INDICATIONS AND USAGE
Vecuronium Bromide bromide is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Vecuronium Bromide bromide is contraindicated in patients known to have a hypersensitivity to it.
Vecuronium Bromide BROMIDE SHOULD BE ADMINISTERED IN CAREFULLY ADJUSTED DOSAGE BY OR UNDER THE SUPERVISION OF EXPERIENCED CLINICIANS WHO ARE FAMILIAR WITH ITS ACTIONS AND THE POSSIBLE COMPLICATIONS THAT MIGHT OCCUR FOLLOWING ITS USE. THE DRUG SHOULD NOT BE ADMINISTERED UNLESS FACILITIES FOR INTUBATION, ARTIFICIAL RESPIRATION, OXYGEN THERAPY, AND REVERSAL AGENTS ARE IMMEDIATELY AVAILABLE. THE CLINICIAN MUST BE PREPARED TO ASSIST OR CONTROL RESPIRATION. TO REDUCE THE POSSIBILITY OF PROLONGED NEUROMUSCULAR BLOCKADE AND OTHER POSSIBLE COMPLICATIONS THAT MIGHT OCCUR FOLLOWING LONG-TERM USE IN THE ICU, Vecuronium Bromide BROMIDE OR ANY OTHER NEUROMUSCULAR BLOCKING AGENT SHOULD BE ADMINISTERED IN CAREFULLY ADJUSTED DOSES BY OR UNDER THE SUPERVISION OF EXPERIENCED CLINICIANS WHO ARE FAMILIAR WITH ITS ACTIONS AND WHO ARE FAMILIAR WITH APPROPRIATE PERIPHERAL NERVE STIMULATOR MUSCLE MONITORING TECHNIQUES (see PRECAUTIONS, Long-term Use in I.C.U. ). In patients who are known to have myasthenia gravis or the myasthenic (Eaton-Lambert) syndrome, small doses of Vecuronium Bromide bromide may have profound effects. In such patients, a peripheral nerve stimulator and use of a small test dose may be of value in monitoring the response to administration of muscle relaxants.
Anaphy l axis
Severe anaphylactic reactions to neuromuscular blocking agents, including Vecuronium Bromide bromide, have been reported. These reactions have in some cases been life-threatening and fatal. Due to the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken. Precautions should also be taken in those individuals who have had previous anaphylactic reactions to other neuromuscular blocking agents since cross-reactivity between neuromuscular blocking agents, both depolarizing and non-depolarizing, has been reported in this class of drugs.
Since allergic cross-reactivity has been reported in this class, request information from your patients about previous anaphylactic reactions to other neuromuscular blocking agents. In addition, inform your patients that severe anaphylactic reactions to neuromuscular blocking agents, including Vecuronium Bromide bromide have been reported.
Vecuronium Bromide is well tolerated without clinically significant prolongation of neuromuscular blocking effect in patients with renal failure who have been optimally prepared for surgery by dialysis. Under emergency conditions in anephric patients some prolongation of neuromuscular blockade may occur; therefore, if anephric patients cannot be prepared for non‑elective surgery, a lower initial dose of Vecuronium Bromide should be considered.
Altered Circulation Time
Conditions associated with slower circulation time in cardiovascular disease, old age, and edematous states resulting in increased volume of distribution may contribute to delay in onset time; therefore, dosage should not be increased.
Experience in patients with cirrhosis or cholestasis has revealed prolonged recovery time in keeping with the role the liver plays in Vecuronium Bromide metabolism and excretion (see CLINICAL PHARMACOLOGY, Pharmacokinetics ). Data currently available do not permit dosage recommendations in patients with impaired liver function.
Long-term Use in I.C.U.
In the intensive care unit, long-term use of neuromuscular blocking drugs to facilitate mechanical ventilation may be associated with prolonged paralysis and/or skeletal muscle weakness that may be first noted during attempts to wean such patients from the ventilator. Typically, such patients receive other drugs such as broad spectrum antibiotics, narcotics and/or steroids and may have electrolyte imbalance and diseases which lead to electrolyte imbalance, hypoxic episodes of varying duration, acid-base imbalance and extreme debilitation, any of which may enhance the actions of a neuromuscular blocking agent. Additionally, patients immobilized for extended periods frequently develop symptoms consistent with disuse muscle atrophy. The recovery picture may vary from regaining movement and strength in all muscles to initial recovery of movement of the facial and small muscles of the extremities then to the remaining muscles. In rare cases recovery may be over an extended period of time and may even, on occasion, involve rehabilitation. Therefore, when there is a need for long-term mechanical ventilation, the benefits-to-risk ratio of neuromuscular blockade must be considered.
Continuous infusion or intermittent bolus dosing to support mechanical ventilation has not been studied sufficiently to support dosage recommendations. IN THE INTENSIVE CARE UNIT, APPROPRIATE MONITORING, WITH THE USE OF A PERIPHERAL NERVE STIMULATOR TO ASSESS THE DEGREE OF NEUROMUSCULAR BLOCKADE IS RECOMMENDED TO HELP PRECLUDE POSSIBLE PROLONGATION OF THE BLOCKADE. WHENEVER THE USE OF Vecuronium Bromide OR ANY NEUROMUSCULAR BLOCKING AGENT IS CONTEMPLATED IN THE ICU, IT IS RECOMMENDED THAT NEUROMUSCULAR TRANSMISSION BE MONITORED CONTINUOUSLY DURING ADMINISTRATION AND RECOVERY WITH THE HELP OF A NERVE STIMULATOR. ADDITIONAL DOSES OF Vecuronium Bromide BROMIDE OR ANY OTHER NEUROMUSCULAR BLOCKING AGENT SHOULD NOT BE GIVEN BEFORE THERE IS A DEFINITE RESPONSE TO T1 OR TO THE FIRST TWITCH. IF NO RESPONSE IS ELICITED, INFUSION ADMINISTRATION SHOULD BE DISCONTINUED UNTIL A RESPONSE RETURNS.
Severe Obesity or Neuromuscular Disease
Patients with severe obesity or neuromuscular disease may pose airway and/or ventilatory problems requiring special care before, during and after the use of neuromuscular blocking agents such as Vecuronium Bromide.
Many drugs used in anesthetic practice are suspected of being capable of triggering a potentially fatal hypermetabolism of skeletal muscle known as malignant hyperthermia. There are insufficient data derived from screening in susceptible animals (swine) to establish whether or not Vecuronium Bromide is capable of triggering malignant hyperthermia.
Vecuronium Bromide has no known effect on consciousness, the pain threshold or cerebration. Administration must be accompanied by adequate anesthesia or sedation.
Prior administration of succinylcholine may enhance the neuromuscular blocking effect of Vecuronium Bromide for injection and its duration of action. If succinylcholine is used before Vecuronium Bromide the administration of Vecuronium Bromide should be delayed until the succinylcholine effect shows signs of wearing off. With succinylcholine as the intubating agent, initial doses of 0.04 to 0.06 mg/kg of Vecuronium Bromide bromide may be administered to produce complete neuromuscular block with clinical duration of action of 25-30 minutes (see CLINICAL PHARMACOLOGY ).
The use of Vecuronium Bromide before succinylcholine, in order to attenuate some of the side effects of succinylcholine, has not been sufficiently studied.
Other nondepolarizing neuromuscular blocking agents (pancuronium, d-tubocurarine, metocurine, and gallamine) act in the same fashion as does Vecuronium Bromide; therefore, these drugs and Vecuronium Bromide may manifest an additive effect when used together. There are insufficient data to support concomitant use of Vecuronium Bromide and other competitive muscle relaxants in the same patient.
Use of volatile inhalational anesthetics such as enflurane, isoflurane, and halothane with Vecuronium Bromide will enhance neuromuscular blockade. Potentiation is most prominent with use of enflurane and isoflurane. With the above agents the initial dose of Vecuronium Bromide bromide may be the same as with balanced anesthesia unless the inhalational anesthetic has been administered for a sufficient time at a sufficient dose to have reached clinical equilibrium (see CLINICAL PHARMACOLOGY ).
Parenteral/intraperitoneal administration of high doses of certain antibiotics may intensify or produce neuromuscular block on their own. The following antibiotics have been associated with various degrees of paralysis: aminoglycosides (such as neomycin, streptomycin, kanamycin, gentamicin, and dihydrostreptomycin); tetracyclines; bacitracin; polymyxin B; colistin; and sodium colistimethate. If these or other newly introduced antibiotics are used in conjunction with Vecuronium Bromide, unexpected prolongation of neuromuscular block should be considered a possibility.
Reconstituted Vecuronium Bromide, which has an acid pH, should not be mixed with alkaline solutions (e.g., barbiturate solutions such as thiopental) in the same syringe or administered simultaneously during intravenous infusion through the same needle or same intravenous line (see DOSAGE AND ADMINISTRATION, Compatibility ).
Experience concerning injection of quinidine during recovery from use of other muscle relaxants suggests that recurrent paralysis may occur. This possibility must also be considered for Vecuronium Bromide. Vecuronium Bromide induced neuromuscular blockade has been counteracted by alkalosis and enhanced by acidosis in experimental animals (cat). Electrolyte imbalance and diseases which lead to electrolyte imbalance, such as adrenal cortical insufficiency, have been shown to alter neuromuscular blockade. Depending on the nature of the imbalance, either enhancement or inhibition may be expected. Magnesium salts, administered for the management of toxemia of pregnancy may enhance the neuromuscular blockade.
Drug/Laboratory Test Interactions
Carcinogenesis, Mutagenesis, Impairment of Fertility
Long-term studies in animals have not been performed to evaluate carcinogenic or mutagenic potential or impairment of fertility.
Pregnancy Category C
Animal reproduction studies have not been conducted with Vecuronium Bromide. It is also not known whether Vecuronium Bromide can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Vecuronium Bromide should be given to a pregnant woman only if clearly needed.
Labor and Delivery
The use of Vecuronium Bromide in patients undergoing cesarean section has been reported in the literature. Following tracheal intubation with succinylcholine, Vecuronium Bromide dosages of 0.04 mg/kg (n = 11) and 0.06 to 0.08 mg/kg (n = 20) were administered. The umbilical venous plasma concentrations were 11% of maternal concentrations at delivery and mean neonate APGAR scores at 5 minutes were ≥9 in both reports. The action of neuromuscular blocking agents may be enhanced by magnesium salts administered for the management of toxemia of pregnancy.
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Vecuronium Bromide is administered to a nursing woman.
Infants under 1 year of age but older than 7 weeks also tested under halothane anesthesia are moderately more sensitive to Vecuronium Bromide on a mg/kg basis than adults and take about 1½ times as long to recover. See DOSAGE AND ADMINISTRATION, USE in Pediatric Patients subsection for recommendations for use in pediatric patients 7 weeks to 16 years of age. The safety and effectiveness of Vecuronium Bromide in pediatric patients less than 7 weeks of age have not been established.
Clinical studies of Vecuronium Bromide did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. There are some reports in the peer reviewed literature of increased effect and longer duration of action of Vecuronium Bromide in the elderly compared to younger patients. However, other reports have found no significant differences between healthy elderly and younger adults. Advanced age or other conditions associated with slower circulation time, may be associated with a delay in onset time (see PRECAUTIONS, Altered Circulation Time ). Nevertheless, recommended doses of Vecuronium Bromide should not be increased in these patients to reduce onset time, as higher doses produce a longer duration of action (see CLINICAL PHARMACOLOGY ). Dose selections for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Close monitoring of neuromuscular function is recommended.
The most frequent adverse reaction to nondepolarizing blocking agents as a class consists of an extension of the drug’s pharmacological action beyond the time period needed. This may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiration insufficiency or apnea.
Inadequate reversal of the neuromuscular blockade is possible with Vecuronium Bromide as with all curariform drugs. These adverse reactions are managed by manual or mechanical ventilation until recovery is judged adequate. Little or no increase in intensity of blockade or duration of action with Vecuronium Bromide is noted from the use of thiobarbiturates, narcotic analgesics, nitrous oxide, or droperidol. See OVERDOSAGE for discussion of other drugs used in anesthetic practice which also cause respiratory depression.
Prolonged to profound extensions of paralysis and/or muscle weakness as well as muscle atrophy have been reported after long-term use to support mechanical ventilation in the intensive care unit (see PRECAUTIONS ). The administration of Vecuronium Bromide has been associated with rare instances of hypersensitivity reactions (bronchospasm, hypotension and/or tachycardia, sometimes associated with acute urticaria or erythema); (see also CLINICAL PHARMACOLOGY ).
There have been post-marketing reports of severe allergic reactions (anaphylactic and anaphylactoid reactions) associated with use of neuromuscular blocking agents, including Vecuronium Bromide bromide. These reactions, in some cases, have been life-threatening and fatal. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency (see WARNINGS and PRECAUTIONS ).
The possibility of iatrogenic overdosage can be minimized by carefully monitoring muscle twitch response to peripheral nerve stimulation.
Excessive doses of Vecuronium Bromide produce enhanced pharmacological effects. Residual neuromuscular blockade beyond the time period needed may occur with Vecuronium Bromide as with other neuromuscular blockers. This may be manifested by skeletal muscle weakness, decreased respiratory reserve, low tidal volume, or apnea. A peripheral nerve stimulator may be used to assess the degree of residual neuromuscular blockade from other causes of decreased respiratory reserve.
Respiratory depression may be due either wholly or in part to other drugs used during the conduct of general anesthesia such as narcotics, thiobarbiturates and other central nervous system depressants.
Under such circumstances the primary treatment is maintenance of a patent airway and manual or mechanical ventilation until complete recovery of normal respiration is assured. Pyridostigmine bromide injection, neostigmine, or edrophonium, in conjunction with atropine or glycopyrrolate will usually antagonize the skeletal muscle relaxant action of Vecuronium Bromide. Satisfactory reversal can be judged by adequacy of skeletal muscle tone and by adequacy of respiration. A peripheral nerve stimulator may also be used to monitor restoration of twitch height. Failure of prompt reversal (within 30 minutes) may occur in the presence of extreme debilitation, carcinomatosis, and with concomitant use of certain broad spectrum antibiotics, or anesthetic agents and other drugs which enhance neuromuscular blockade or cause respiratory depression of their own. Under such circumstances the management is the same as that of prolonged neuromuscular blockade. Ventilation must be supported by artificial means until the patient has resumed control of his respiration. Prior to the use of reversal agents, reference should be made to the specific package insert of the reversal agent.
The effects of hemodialysis and peritoneal dialysis on plasma levels of Vecuronium Bromide and its metabolite are unknown.
DOSAGE AND ADMINISTRATION
Vecuronium Bromide bromide for injection is for intravenous use only.
This drug should be administered by or under the supervision of experienced clinicians familiar with the use of neuromuscular blocking agents. Dosage must be individualized in each case. The dosage information which follows is derived from studies based upon units of drug per unit of body weight and is intended to serve as a guide only, especially regarding enhancement of neuromuscular blockade of Vecuronium Bromide by volatile anesthetics and by prior use of succinylcholine (see PRECAUTIONS, Drug Interactions ). Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
To obtain maximum clinical benefits of Vecuronium Bromide and to minimize the possibility of overdosage, the monitoring of muscle twitch response to peripheral nerve stimulation is advised.
The recommended initial dose of Vecuronium Bromide bromide is 0.08 to 0.1 mg/kg (1.4 to 1.75 times the ED90) given as an intravenous bolus injection. This dose can be expected to produce good or excellent non-emergency intubation conditions in 2.5 to 3 minutes after injection. Under balanced anesthesia, clinically required neuromuscular blockade lasts approximately 25-30 minutes, with recovery to 25% of control achieved approximately 25 to 40 minutes after injection and recovery to 95% of control achieved approximately 45-65 minutes after injection. In the presence of potent inhalation anesthetics, the neuromuscular blocking effect of Vecuronium Bromide is enhanced. If Vecuronium Bromide is first administered more than 5 minutes after the start of inhalation agent or when steady-state has been achieved, the initial Vecuronium Bromide bromide dose may be reduced by approximately 15%, i.e., 0.06 to 0.085 mg/kg.
Prior administration of succinylcholine may enhance the neuromuscular blocking effect and duration of action of Vecuronium Bromide. If intubation is performed using succinylcholine, a reduction of initial dose of Vecuronium Bromide bromide to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia may be required.
During prolonged surgical procedures, maintenance doses of 0.01 to 0.015 mg/kg of Vecuronium Bromide bromide are recommended; after the initial Vecuronium Bromide bromide injection, the first maintenance dose will generally be required within 25 to 40 minutes. However, clinical criteria should be used to determine the need for maintenance doses.
Since Vecuronium Bromide lacks clinically important cumulative effects, subsequent maintenance doses, if required, may be administered at relatively regular intervals for each patient, ranging approximately from 12 to 15 minutes under balanced anesthesia, slightly longer under inhalation agents. (If less frequent administration is desired, higher maintenance doses may be administered.)
Should there be reason for the selection of larger doses in individual patients, initial doses ranging from 0.15 mg/kg up to 0.28 mg/kg have been administered during surgery under halothane anesthesia without ill effects to the cardiovascular system being noted as long as ventilation is properly maintained (see CLINICAL PHARMACOLOGY ).
Use by Continuous Infusion
After an intubating dose of 80 to 100 mcg/kg, a continuous infusion of 1 mcg/kg/min can be initiated approximately 20-40 min later. Infusion of Vecuronium Bromide should be initiated only after early evidence of spontaneous recovery from the bolus dose. Long-term intravenous infusion to support mechanical ventilation in the intensive care unit has not been studied sufficiently to support dosage recommendations (see PRECAUTIONS ).
The infusion of Vecuronium Bromide should be individualized for each patient. The rate of administration should be adjusted according to the patient’s twitch response as determined by peripheral nerve stimulation. An initial rate of 1 mcg/kg/min is recommended, with the rate of the infusion adjusted thereafter to maintain a 90% suppression of twitch response. Average infusion rates may range from 0.8 to 1.2 mcg/kg/min.
Inhalation anesthetics, particularly enflurane and isoflurane may enhance the neuromuscular blocking action of nondepolarizing muscle relaxants. In the presence of steady-state concentrations of enflurane or isoflurane, it may be necessary to reduce the rate of infusion 25-60 percent, 45‑60 min after the intubating dose. Under halothane anesthesia it may not be necessary to reduce the rate of infusion.
Spontaneous recovery and reversal of neuromuscular blockade following discontinuation of Vecuronium Bromide infusion may be expected to proceed at rates comparable to that following a single bolus dose (see CLINICAL PHARMACOLOGY ).
Infusion solutions of Vecuronium Bromide can be prepared by mixing Vecuronium Bromide with an appropriate infusion solution such as Dextrose Injection 5%, Sodium Chloride Injection 0.9%, Dextrose (5%) and Sodium Chloride Injection, or Lactated Ringer’s Injection.
Unused portions of infusion solutions should be discarded.
Infusion rates of Vecuronium Bromide bromide can be individualized for each patient using the following table:
The following table is guideline for mL/min delivery for a solution of 0.1 mg/mL (10 mg in 100 mL) with an infusion pump.
NOTE: If a concentration of 0.2 mg/mL is used (20 mg in 100 mL), the rate should be decreased by one-half.
USE in Pediatric Patients
Older pediatric patients (10 to 16 years of age) have approximately the same dosage requirements (mg/kg) as adults and may be managed the same way. Younger pediatric patients (1 to 10 years of age) may require a slightly higher initial dose and may also require supplementation slightly more often than adults.
Infants under one year of age but older than 7 weeks are moderately more sensitive to Vecuronium Bromide on a mg/kg basis than adults and take about 1½ times as long to recover. See also subsection of PRECAUTIONS titled Pediatric Use . Information presently available does not permit recommendation on usage in pediatric patients less than 7 weeks of age (see PRECAUTIONS ). There are insufficient data concerning continuous infusion of Vecuronium Bromide in pediatric patients, therefore, no dosing recommendations can be made.
Vecuronium Bromide bromide is compatible in solution with:
Sodium Chloride Injection 0.9%
Dextrose Injection 5%
Sterile Water for Injection
Dextrose (5%) and Sodium Chloride 0.9% Injection
Lactated Ringer’s Injection
Use within 24 hours of mixing with the above solutions.
Vecuronium Bromide bromide is also compatible in solution with:
Bacteriostatic Water for Injection ( NOT FOR USE IN NEWBORNS ). Use within 5 days of mixing with the above solution.
Reconstituted Vecuronium Bromide bromide, which has an acid pH, should not be mixed with alkaline solutions (e.g., barbiturate solutions such as thiopental) in the same syringe or administered simultaneously during intravenous infusion through the same needle or through the same intravenous line.
See DOSAGE AND ADMINISTRATION – Compatibility: for diluents compatible with Vecuronium Bromide Bromide for Injection.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
Store dry powder at 20 to 25ºC (68 to 77ºF). Protect from light.
Hospira, Inc., Lake Forest, IL 60045 USA
*1 mg/mL when
reconstituted to 10 mL.
FOR IV USE ONLY
Hospira, Inc., Lake Forest, IL 60045 USA
Vecuronium Bromide pharmaceutical active ingredients containing related brand and generic drugs:
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Vecuronium Bromide available forms, composition, doses:
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Vecuronium Bromide destination | category:
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Vecuronium Bromide Anatomical Therapeutic Chemical codes:
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Vecuronium Bromide pharmaceutical companies:
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Frequently asked QuestionsCan i drive or operate heavy machine after consuming Vecuronium Bromide?
Depending on the reaction of the Vecuronium Bromide after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Vecuronium Bromide not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.Is Vecuronium Bromide addictive or habit forming?
Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
ReviewsDrugs.com conducted a study on Vecuronium Bromide, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Vecuronium Bromide consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.
The information was verified by Dr. Arunabha Ray, MD Pharmacology