Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/3254
| Predicate | Object |
|---|---|
| rdf:type | |
| rdfs:label |
Vecuronium Bromide (Injection, Powder, Lyophilized, For Solution)
|
| dailymed-instance:dosage |
Vecuronium 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 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 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 is 0.08 to 0.10 mg/kg (1.4
to 1.75 times the ED) 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 is enhanced. If vecuronium is first administered
more than 5 minutes after the start of inhalation agent or when steady-state
has been achieved, the initial vecuroniumbromide dose may be reduced by approximately
15%, i.e., 0.060 to 0.085 mg/kg. Prior administration
of succinylcholine may enhance the neuromuscular blocking effect and duration
of action of vecuronium. If intubation is performed using succinylcholine,
a reduction of initial dose of vecuronium bromide to 0.04-0.06 mg/kg with
inhalation anesthesia and 0.05-0.06 mg/kg with balanced anesthesia may
be required. During prolonged surgical procedures, maintenance
doses of 0.010 to 0.015 mg/kg of vecuronium bromide are recommended; after
the initial vecuronium 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 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 80-100 mcg/kg, a continuous infusion of 1 mcg/kg/min can be initiated
approximately 20-40 min later. Infusion of vecuronium 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 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 infusion may be expected to proceed at rates comparable to that
following a single bolus dose (see CLINICAL PHARMACOLOGY). Infusion solutions of vecuronium can be
prepared by mixing vecuronium 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 can be individualized for each patient using the
following table: * 10 mg of vecuronium bromide in 100 mL solution ���20
mg of vecuronium bromide in 100 mL solution 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. Dosage in Pediatric Patients: Older pediatric patients
(10 to 17 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 on a mg/kg basis than adults and take about 1��times as
long to recover. See also subsection of PRECAUTIONS titled Pediatric Use. Information
presently available does not permit recommendation on usage in neonates (see PRECAUTIONS ). There are insufficient data concerning
continuous infusion of vecuronium in pediatric patients, therefore, no dosing
recommendations can be made. Compatibility: Vecuronium bromide is compatible in solution with: Sodium
Chloride Injection 0.9% Dextrose Injection 5% Sterile
Water for Injection Dextrose (5%) and Sodium Chloride
Injection Lactated Ringer's Injection Use
within 24 hours of mixing with the above solutions. After Reconstitution: Parenteral drug products should be inspected visually for
particulate matter and discoloration prior to administration whenever solution
and container permit.
|
| dailymed-instance:descripti... |
Vecuronium bromide for injection is a nondepolarizing neuromuscular
blocking agent of intermediate duration, chemically designated as piperidinium,
1-[(2��, 3��, 5��, 16��, 17��)-3, 17-bis (acetyloxy)-2-(1-piperidinyl)
androstan-16-yl]-1-methyl-, bromide. Vecuronium bromide for injection is prepared
as a solution and lyophilized in its final container. The structural formula
is: Its chemical formula is CHBrNOwith
molecular weight 637.74. Vecuronium bromide is supplied
as a sterile nonpyrogenic freeze-dried buffered cake of very fine microscopic
crystalline particles for intravenous injection only. Each 10 mL vial contains
10 mg vecuronium bromide, 20.75 mg citric acid anhydrous, 16.25 mg sodium
phosphate dibasic anhydrous, 97 mg mannitol (to adjust tonicity), sodium hydroxide
and/or phosphoric acid to buffer and adjust to a pH of 4 (3.5 to 4.5). Each
20 mL vial contains 20 mg of vecuronium bromide, 41.5 mg citric acid
anhydrous, 32.5 mg sodium phosphate dibasic anhydrous, 194 mg mannitol (to
adjust tonicity), sodium hydroxide and/or phosphoric acid to buffer and adjust
to a pH of 4 (3.5 to 4.5). Bacteriostatic water for injection,USP when supplied
contains 0.9% w/v BENZYL ALCOHOL, WHICH IS NOT FOR USE IN NEWBORNS.
|
| dailymed-instance:clinicalP... |
Vecuronium for injection is a nondepolarizing neuromuscular
blocking agent possessing all of the characteristic pharmacological actions
of this class of drugs (curariform). It acts by competing for cholinergic
receptors at the motor end-plate. The antagonism to acetylcholine is inhibited
and neuromuscular block is reversed by acetylcholinesteraseinhibitors such
as neostigmine, edrophonium, and pyridostigmine. Vecuronium is about 1/3 more
potent than pancuronium; the duration of neuromuscular blockade produced by
vecuronium bromide is shorter than that of pancuronium at initially equipotent
doses. The time to onset of paralysis decreases and the duration of maximum
effect increases with increasing vecuronium bromide doses. The use of a peripheral
nerve stimulator is recommended in assessing the degree of muscular relaxation
with all neuromuscular blocking drugs. The ED(dose required
to produce 90% suppression of the muscle twitch response with balanced anesthesia)
has averaged 0.057 mg/kg (0.049 to 0.062 mg/kg in various studies). An initial
vecuronium bromide dose of 0.08 to 0.10 mg/kg generally produces first depression
of twitch in approximately 1 minute, good or excellent intubation conditions
within 2.5 to 3 minutes, and maximum neuromuscular blockade within 3
to 5 minutes of injection in most patients. Under balanced
anesthesia, the time to recovery to 25% of control (clinical duration) is
approximately 25 to 40 minutes after injection and recovery is usually 95%
complete approximately 45-65 minutes after injection of intubating dose. The
neuromuscular blocking action of vecuronium is slightly enhanced in the presence
of potent inhalation anesthetics. If vecuronium is first administered more
than 5 minutes after the start of the inhalation of enflurane, isoflurane,
or halothane, or when steady state has been achieved, the intubating dose
of vecuronium bromide may be decreased by approximately 15% (see DOSAGE AND ADMINISTRATION section). Prior administration
of succinylcholine may enhance the neuromuscular blocking effect of vecuronium
and its duration of action. With succinylcholine as the intubating agent,
initial doses of 0.04-0.06 mg/kg of vecuronium will produce complete
neuromuscular block with clinical duration of action of 25-30 minutes. If
succinylcholine is used prior to vecuronium, the administrationof vecuronium
should be delayed until the patient starts recovering from succinylcholine-induced
neuromuscular blockade. The effect of prior use of other nondepolarizing neuromuscular
blocking agents on the activity of vecuronium has not been studied (see PRECAUTIONS, Drug Interactions ). Repeated
administration of maintenance doses of vecuronium has little or no cumulative
effect on the duration of neuromuscular blockade. Therefore, repeat doses
can be administered at relatively regular intervals with predictable results.
After an initial dose of 0.08 to 0.10 mg/kg under balanced anesthesia, the
first maintenance dose (suggested maintenance dose is 0.010 to 0.015 mg/kg)
is generally required within 25 to 40 minutes; subsequent maintenance doses,
if required, may be administered at approximately 12 to 15 minute intervals.
Halothane anesthesia increases the clinical duration of the maintenance dose
only slightly. Under enflurane a maintenance dose of 0.010 mg/kg is approximately
equal to0.015 mg/kg dose under balanced anesthesia. The
recovery index (time from 25% to 75% recovery) is approximately 15-25 minutes
under balanced or halothane anesthesia. When recovery from vecuronium neuromuscular
blocking effect begins, it proceeds more rapidly than recovery from pancuronium.
Once spontaneous recovery has started, the neuromuscular block produced by
vecuronium is readily reversed with various anticholinesterase agents, e.g.,
pyridostigmine, neostigmine, or edrophonium in conjunction with an anticholinergic
agent such as atropine or glycopyrrolate. Rapid recovery is a finding consistent
with vecuronium short elimination half-life, although there have been occasional
reports of prolonged neuromuscular blockade in patients in the intensive care
unit (see PRECAUTIONS ). The
administration of clinical doses of vecuronium bromide is not characterized
by laboratory or clinical signs of chemically mediated histamine release.
This does not preclude the possibility of rare hypersensitivity reactions
(see ADVERSE REACTIONS). Pharmacokinetics: At clinical doses of 0.04-0.10
mg/kg, 60-80% of vecuronium bromide is usually bound to plasma protein. The
distribution half-life following a single intravenous dose (range 0.025-0.280
mg/kg) is approximately 4 minutes. Elimination half-life over this sample
dosage range is approximately 65-75 minutes in healthy surgical patients and
in renal failure patients undergoing transplant surgery. In
late pregnancy, elimination half-life may be shortened to approximately 35-40
minutes. The volume of distribution at steady state is approximately 300-400
mL/kg; systemic rate of clearance is approximately 3-4.5 mL/minute/kg. In
man, urine recovery of vecuronium varies from 3-35% within 24 hours. Data
derived from patients requiring insertion of a T-tube in the common bile duct
suggests that 25-50% of a total intravenous dose of vecuronium may be excreted
in bile within 42 hours. Only unchangedvecuronium has been detected
in human plasma following use during surgery. In addition, one metabolite
3-desacetyl vecuronium has been rarely detected in human plasma following
prolonged clinical use in the I.C.U. (see PRECAUTIONS:
Long Term Use in I.C.U.). One metabolite, 3-desacetyl vecuronium
has been recovered in the urine of some patients in quantities that account
for up to 10% of injected dose; 3-desacetyl vecuronium has also been recovered
by T-tube in some patients accounting for up to 25% of the injected dose. This
metabolite has been judged by animal screening (dogs and cats) to have 50%
or more of the potency of vecuronium; equipotent doses are of approximately
the same duration as vecuronium in dogs and cats. Biliary excretion accounts
for about half the dose of vecuronium bromide within 7 hours in the anesthetized
rat. Circulatory bypass of the liver (cat preparation) prolongs recovery from
vecuronium. Limited data derived from patients with cirrhosis or cholestasis
suggests that some measurements of recovery may be doubled in such patients.
In patients with renal failure, measurements of recovery do not differ significantly
from similar measurements in healthy patients. Studies
involving routine hemodynamic monitoring in good risk surgical patients reveal
that the administration of vecuronium bromide in doses up to three times that
needed to produce clinical relaxation (0.15 mg/kg) did not produce clinically
significant changes in systolic, diastolic or mean arterial pressure. The
heart rate, under similar monitoring, remained unchanged in some studies and
was lowered by a mean of up to 8% in other studies. A large dose of 0.28 mg/kg
administered during a period of no stimulation, while patients were being
prepared for coronary artery bypass grafting was not associated with alterations
in rate-pressure-product or pulmonary capillary wedge pressure. Systemic vascular
resistance was lowered slightly and cardiac output was increased insignificantly.
(The drug has not been studied in patients with hemodynamic dysfunction secondary
to cardiac valvular disease). Limited clinical experience with use of vecuronium
during the surgery for pheochromocytoma has shown that administration of this
drug is not associated with changes in blood pressure or heart rate. Unlike
other nondepolarizing skeletal muscle relaxants, vecuronium has no clinically
significant effects on hemodynamic parameters. Vecuronium will not counteract
those hemodynamic changes or known side effects produced by or associated
with anesthetic agents, other drugs or various other factors known to alter
hemodynamics.
|
| dailymed-instance:activeIng... | |
| dailymed-instance:contraind... |
Vecuronium bromide is contraindicated in patients known to
have a hypersensitivity to it.
|
| dailymed-instance:supply |
Store dry powder at 20 to 25��C (68 to 77��F).
[See USP Controlled Room Temperature.] Protect from light. December, 2004 ��Hospira 2004 EN-0775 Printed
in USA HOSPIRA, INC., LAKE
FOREST, IL 60045 USA
|
| dailymed-instance:boxedWarn... |
THIS DRUG SHOULD BE ADMINISTERED
BY ADEQUATELY TRAINED
INDIVIDUALS FAMILIAR WITH ITS
ACTIONS, CHARACTERISTICS, AND HAZARDS.
|
| dailymed-instance:activeMoi... | |
| dailymed-instance:inactiveI... | |
| dailymed-instance:precautio... |
Renal Failure: Vecuronium
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
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. Hepatic
Disease: Experience in patients with cirrhosis or cholestasis has
revealed prolonged recovery time in keeping with the role the liver plays
in vecuronium 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 OR ANYNEUROMUSCULAR 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 OR ANY OTHER NEUROMUSCULAR BLOCKING AGENT SHOULD NOT BE GIVEN BEFORE
THERE IS A DEFINITE RESPONSE TO TOR 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. Malignant
Hyperthermia: 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 is capable of triggering malignant hyperthermia. C.N.S.: Vecuronium has no known effect on consciousness,
the pain threshold or cerebration. Administration must be accompanied by adequate
anesthesia or sedation.<br/>Drug Interactions:: Prior administration of succinylcholine may enhance the neuromuscular
blocking effect of vecuronium for injection and its duration of action. If
succinylcholine is used before vecuronium the administration of vecuronium
should be delayed until the succinylcholine effect shows signs of wearing
off. With succinylcholine as the intubating agent, initial doses of 0.04-0.06
mg/kg of vecuronium 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 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; therefore, these drugs
and vecuronium may manifest an additive effect when used together. There are
insufficient data to support concomitant use of vecuronium and other competitive
muscle relaxants in the same patient. Inhalational
Anesthetics: Use of volatile inhalational anesthetics such as enflurane,
isoflurane, and halothane with vecuronium will enhance neuromuscular blockade.
Potentiation is most prominent with use of enflurane and isoflurane. With
the above agents the initial dose of vecuronium 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). Antibiotics: 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, unexpected prolongation
of neuromuscular block should be considered a possibility. Other: 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.
Vecuronium 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.<br/>Drug/Laboratory Test Interactions:: None known.<br/>Carcinogenesis, Mutagenesis, Impairment of Fertility:: Long-term studies in animals have not been performed to evaluate
carcinogenic or mutagenic potential or impairment of fertility.<br/>Pregnancy:: Pregnancy Category C: Animal
reproduction studies have not been conducted with vecuronium. It is also not
known whether vecuronium can cause fetal harm when administered to a pregnant
woman or can affect reproduction capacity. Vecuronium should be given to a
pregnant woman only if clearly needed.<br/>Pediatric Use:: Infants under 1 year of age but older than 7 weeks also tested
under halothane anesthesia are moderately more sensitive to vecuronium on
a mg/kg basis than adults and take about 1��times as long to recover.
Information presently available does not permit recommendations for usage
in neonates.
|
| dailymed-instance:overdosag... |
The possibility of iatrogenic overdosage can be minimized
by carefully monitoring muscle twitch response to peripheral nerve stimulation. Excessive
doses of vecuronium produce enhanced pharmacological effects. Residual neuromuscular
blockade beyond the time period needed may occur with vecuronium 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. 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 twitchheight. 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.
|
| dailymed-instance:genericMe... |
Vecuronium Bromide
|
| dailymed-instance:fullName |
Vecuronium Bromide (Injection, Powder, Lyophilized, For Solution)
|
| dailymed-instance:adverseRe... |
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 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 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 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 ).
|
| dailymed-instance:warning |
VECURONIUM 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 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). In patients who are known to have myasthenia gravis or the myasthenic
(Eaton-Lambert) syndrome, small doses of vecuronium 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.
|
| dailymed-instance:indicatio... |
Vecuronium bromide is indicated as an adjunct to general
anesthesia, to facilitate endotracheal intubation and to provide skeletal
muscle relaxation during surgery or mechanical ventilation.
|
| dailymed-instance:represent... | |
| dailymed-instance:routeOfAd... | |
| dailymed-instance:name |
Vecuronium Bromide
|