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 bromide
Clinical data
AHFS/Drugs.com monograph
  • US: C (Risk not ruled out)
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
50700-72-6 Yes
M03AC03
PubChem CID 39764
UNII 7E4PHP5N1D 
ChEMBL CHEMBL1201219 
Chemical data
Formula C34H57BrN2O4
637.73 g/mol
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Vecuronium bromide (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%.

Non-medical usage

Vecuronium bromide can be used as part of a drug cocktail that prisons in the United States use as a means to put a condemned prisoner to death. Vecuronium bromide is used to paralyze the prisoner and stop his or her breathing, in conjunction with a sedative and potassium chloride to stop the prisoner's heart. Injections of vecuronium bromide without proper sedation allow the person to be fully awake but unable to move in response to pain.[1]

In 2001, Japanese nurse Daisuke Mori was reported to have murdered 10 patients using vecuronium bromide.[2] He was convicted of murder and was sentenced to life imprisonment.[3]

References

  1. ↑ "One Execution Botched, Oklahoma Delays the Next". New York Times. April 29, 2014.
  2. ↑ "Japanese nurse kills 10 patients, says wanted to trouble hospital". The Indian Express. 2001-01-10. Retrieved 2008-03-22.
  3. ↑ "Nurse gets life for patient slaying". The Japan Times Weekly. April 10, 2004. Retrieved October 26, 2011.