Pharmacology · Neuromuscular blockers
Vecuronium !
Intermediate-acting non-depolarising aminosteroid muscle relaxant that releases no histamine. Sugammadex reverses it.
Updated 2026-11-01
Also called: Vecuronium bromide
There is no structure with vecuronium. The figure shows rocuronium, another aminosteroid, at the acetylcholine site of the Torpedo ray muscle-type nicotinic receptor.
Mechanism of action
Vecuronium, an aminosteroid, competes with acetylcholine for the nicotinic receptor of the motor end plate without activating it, so skeletal muscle does not contract. Unlike pancuronium, it barely blocks cardiac muscarinic receptors, so it causes little tachycardia, and it releases no histamine.
- Competes with acetylcholine at the nicotinic receptor
- The end plate does not reach threshold: flaccid paralysis
- Little vagal or histamine effect: stable haemodynamics
- Reversed with neostigmine or sugammadex
Pharmacokinetics
- Metabolism
- Hepatic; its metabolite 3-desacetylvecuronium keeps much of the activity and accumulates with prolonged use.
- Elimination
- Mainly biliary and to a lesser extent renal; cirrhosis and cholestasis prolong recovery.
- Onset and duration
- Intermediate duration; onset is delayed with old age, heart disease or oedema.
Indications
- Tracheal intubation and muscle relaxation in surgery
- Facilitating mechanical ventilation in intensive care
Adverse effects
Common
- Prolonged muscle weakness
- Residual block on waking
Contraindications
- Hypersensitivity to vecuronium
Key interactions
- Halogenated agents
- Increase the duration of block.
- Aminoglycosides, tetracyclines, polymyxins, magnesium, quinidine
- Enhance the block or make it recur.
- Alkaline solutions such as thiopental
- Incompatible in the same syringe or line.
What is monitored
- Train-of-four
- Ventilation and saturation
- Liver function with prolonged use
Administration and safety
- Powder for reconstitution; if bacteriostatic water (benzyl alcohol) is used, it is not given to newborns.
- Paralysing agent: store apart with warnings; confirm the product before use.
- Do not mix with alkaline solutions in the same syringe or line.
Nursing care
- Check adequate sedation and analgesia before and during the block.
- Regular train-of-four and sedation assessment in the ICU.
- Care for the eyes and skin of the paralysed patient.
- After reversal: strength, breathing and saturation.
Pregnancy and breastfeeding
It has been used for caesarean sections; late in pregnancy its half-life may shorten, and magnesium sulfate enhances the block.
Test yourself
Think of the answer, then tap the question to see it.
Why does vecuronium cause less tachycardia than pancuronium?
Because it barely blocks the muscarinic receptors of the sinus node and lacks pancuronium's vagolytic effect.
Which patient will recover more slowly from vecuronium?
The patient with cirrhosis or cholestasis, because vecuronium is eliminated mainly by the liver and bile.
Why can prolonged vecuronium in the ICU leave the patient weak for longer?
Its active metabolite 3-desacetylvecuronium accumulates, and prolonged block with corticosteroids is linked to myopathy.
Related drugs
← Back to the class: Neuromuscular blockers
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - VECURONIUM BROMIDE injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 13 (McGraw Hill, 2023); eEML - Electronic Essential Medicines List (World Health Organization, 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.