Non-Depolarising Neuromuscular Blocking Agent Pregnancy: Insufficient data in pregnancy - give only when benefits outweigh risks. Caesarean section: shown safe up to 100 micrograms/kg; dose should not exceed 100 micrograms/kg. In patients receiving magnesium sulfate for toxaemia, reduce dose and titrate to twitch. Breast-feeding: excretion in human milk unknown.

Vecuronium

Brand names: Norcuron

Vecuronium is an intermediate-acting non-depolarising aminosteroid neuromuscular blocking agent used to provide muscle relaxation during anaesthesia and to facilitate tracheal intubation and mechanical ventilation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 80-100 micrograms/kg

Route: Intravenous

Frequency: Single intubating dose (adults)

Standard intubating dose during routine anaesthesia: 80-100 micrograms/kg, giving adequate intubation conditions within 90-120 seconds in nearly all patients. Maintenance dose: 20-30 micrograms/kg, best given when twitch height has recovered to 25% of control. After intubation with suxamethonium: 30-50 micrograms/kg (delay until clinical recovery from suxamethonium block). Continuous infusion: after a loading dose, 0.8-1.4 micrograms/kg/min once block starts to recover. Higher doses (150-300 micrograms/kg) have been used when larger doses are selected (decreases onset time, increases duration). In caesarean section and neonatal surgery the dose should not exceed 100 micrograms/kg. Overweight/obese patients (>=30% above ideal body weight): reduce dose to ideal body weight. Elderly: same intubation/maintenance doses as younger adults but duration of action is prolonged. Individualise dose and use neuromuscular monitoring. Paediatric (from source, not per-kg simplifiable): adolescents 12-17 years and children 2-11 years - same 80-100 micrograms/kg intubation and 20-30 micrograms/kg maintenance as adults (maintenance more frequent in children); neonates 0-27 days and infants 28 days-23 months - initial test dose 10-20 micrograms/kg then incremental doses; verify against a children's formulary. Reconstitute with water for injections.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to vecuronium bromide, to the bromide ion, or to any excipient

Side effects

Prolonged neuromuscular block / delayed recovery from anaesthesia
Anaphylactic and anaphylactoid reactions, including anaphylactic/anaphylactoid shock (most reported post-marketing)
Hypotension, circulatory collapse and shock, flushing
Tachycardia
Bronchospasm; skin reactions (urticaria, rash, angioneurotic oedema); muscular weakness/steroid myopathy after long-term ICU use

Interactions

Inhalational (volatile) anaesthetics e.g. enflurane, isoflurane, halothane - potentiate neuromuscular block (reduce dose / infusion rate)
Prior succinylcholine (suxamethonium) - enhances the neuromuscular blocking effect and duration
Other non-depolarising neuromuscular blocking agents - additive effect
Magnesium salts (e.g. magnesium sulfate) - enhance neuromuscular block; reduce vecuronium dose and titrate to twitch response

Clinical monograph

How it works

It competitively antagonises acetylcholine at nicotinic receptors of the neuromuscular junction, preventing depolarisation and producing skeletal muscle paralysis.

Prescribing in practice

Causes complete respiratory paralysis, so must only be used where facilities for intubation and controlled ventilation are immediately available and by clinicians experienced in airway management.
Block is potentiated by aminoglycosides, magnesium and volatile anaesthetics, and is prolonged in hepatic or renal impairment.
Provides no sedation or analgesia, so adequate anaesthesia must be ensured to avoid awareness during paralysis.

Monitoring

Use peripheral nerve stimulation to monitor the depth of neuromuscular block and to guide dosing and confirm recovery before extubation.

Counselling the patient

This is given by an anaesthetist as part of general anaesthesia.
Ensure adequate sedation and analgesia are maintained while the patient is paralysed.

Evidence & guidelines

Vecuronium is an established neuromuscular blocker used routinely in anaesthetic practice as described in the SPC.

Reference: Miller's Anaesthesia 9th Ed; AAGBI Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

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