Vecuronium bromide

Vecuronium bromide

Systematic (IUPAC) name
[(2S,3S,5S,8R,9S,10S,13S,14S,16S,17S)- 17-acetyloxy-10,13-dimethyl-16-(1-methyl-3,4, 5,6-tetrahydro-2H-pyridin-1-yl)-2-(1-piperidyl)- 2,3,4,5,6,7,8,9,11,12,14,15,16,17-tetradecahydro- 1H-cyclopenta[a]phenanthren-3-yl] acetate
Clinical data
AHFS/Drugs.com	monograph
Pregnancy cat.	C (US)
Legal status	℞-only (US)
Routes	Intravenous
Pharmacokinetic data
Bioavailability	100% (IV)
Metabolism	liver 30%
Half-life	51–80 minutes (longer with renal failure)
Excretion	Fecal (40-75%) and renal (30% as unchanged drug and metabolites)
Identifiers
CAS number	50700-72-6 Y
ATC code	M03AC03
PubChem	CID 39765
UNII	7E4PHP5N1D N
ChEMBL	CHEMBL1201219 N
Chemical data
Formula	C34H57N2O4+
Mol. mass	557.827 g/mol
N (what is this?)  (verify)

Vecuronium (Norcuron) is a muscle relaxant in the category of non-depolarizing blocking agents. 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. Although vecuronium bromide is often thought of as a muscle relaxant, it may be more accurate to classify it as a paralyzing agent. It is commercially available as ampoules containing 4 or 10 mg of the drug in powder form which needs to be dissolved in distilled water prior to administration to the patient.

Development

Vecuronium's structure is derived from the same aminosteroid structure as pancuronium, but it is missing the methyl group on the piperidine nitrogen that is attached to the 'A' ring, making it monoquaternary, like D-tubocurarine. It has the same configuration at all ten stereocentres as pancuronium, and is a single-isomer preparation.

Clinical pharmacology

Vecuronium operates by competing for the cholinoceptors at the motor end plate thereby exerting its muscle-relaxing properties which are used adjunctively to general anesthesia. 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 to 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 a steady state has been achieved, the intubating dose of vecuronium may be decreased by approximately 15%.

Vecuronium is an aminosteroid.

Media

In 2001, Japanese nurse Daisuke Mori was reported to have murdered 10 patients using vecuronium bromide.^[1] He was convicted of murder and was sentenced to life imprisonment.^[2]

References