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 aminosteroid non-depolarising neuromuscular blocking agent given intravenously during general anaesthesia to provide muscle relaxation for intubation and surgery.

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 for surgical procedures (adults)

Surgical / anaesthesia context. Standard intubating dose during routine anaesthesia: 80-100 micrograms/kg, giving adequate intubation conditions within 90-120 seconds. Muscle relaxation for short to long lasting surgical procedures. Maintenance dose: 20-30 micrograms/kg, best given when twitch height has recovered to 25% of control (more frequently in children as duration is shorter). After intubation with suxamethonium: 30-50 micrograms/kg (delay until clinical recovery from suxamethonium block). Continuous infusion during surgery: after a loading dose, 0.8-1.4 micrograms/kg/min once block starts to recover, titrated to twitch response. Higher doses (150-300 micrograms/kg) used when larger doses are selected during surgery (decreases onset, increases duration). Caesarean section and neonatal surgery: dose should not exceed 100 micrograms/kg. Overweight/obese patients (>=30% above ideal body weight): reduce to ideal body weight. Individualise with neuromuscular monitoring; administer only by/under supervision of experienced clinicians. Paediatric (from source, not per-kg simplifiable): children 2-11 years and adolescents 12-17 years - same 80-100 micrograms/kg intubation and 20-30 micrograms/kg maintenance as adults; 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 reversible skeletal muscle paralysis.

Prescribing in practice

It causes complete respiratory paralysis and must only be used with controlled ventilation by clinicians skilled in airway management, ensuring adequate anaesthesia since it provides no sedation or analgesia.
Block is prolonged in hepatic impairment, and is potentiated by aminoglycosides, magnesium, volatile anaesthetics and hypothermia.
Confirm adequate recovery of neuromuscular function, using a reversal agent where appropriate, before extubation to avoid residual paralysis.

Monitoring

Monitor depth of neuromuscular blockade with a peripheral nerve stimulator and maintain continuous ventilatory and haemodynamic monitoring until full recovery.

Counselling the patient

This medicine is given while you are asleep under anaesthesia to relax your muscles for surgery.
You may feel mild muscle aches afterwards, which settle on their own.

Evidence & guidelines

Vecuronium is a long-established neuromuscular blocker with a well-defined profile described in the SPC and UK anaesthetic practice.

Reference: Norcuron SPC; AAGBI NAP6 Perioperative Anaphylaxis Report; 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.

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