[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/) › Vecuronium

[Pharmacology](https://durgical.com/en/pharmacology/) · [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/)

# Vecuronium

Intermediate-acting non-depolarising aminosteroid muscle relaxant that releases no histamine. Sugammadex reverses it.

Updated 2026-11-01

- Class: [Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/neuromuscular-blockers/)
- Receptor: Muscle nicotinic acetylcholine receptor (motor end plate)
- ATC code: M03AC03
- WHO Model List of Essential Medicines

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

Also called: Vecuronium bromide

◎**Muscle nicotinic acetylcholine receptor (motor end plate)**Vecuronium

ⓘ There is no structure with vecuronium. The figure shows rocuronium, another aminosteroid, at the acetylcholine site of the Torpedo ray muscle-type nicotinic receptor.

**Target in 3D:** Muscle nicotinic acetylcholine receptor (motor end plate). PDB structure 8ESK (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8ESK) · Drag to rotate · pinch to zoom

## 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

### Serious (rare, important)

- Anaphylaxis
- Prolonged apnoea and paralysis, especially with liver failure or long ICU use
- Critical illness myopathy with corticosteroids

## 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.

## Memory aid

VECuronium: «Via the bile, Easy on the heart, Careful in cirrhosis».

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/vecuronium/)

## Related drugs

- [Rocuronium](https://durgical.com/en/pharmacology/rocuronium/)
- [Pancuronium](https://durgical.com/en/pharmacology/pancuronium/)
- [Sugammadex](https://durgical.com/en/pharmacology/sugammadex/)

[← Back to the class: Neuromuscular blockers](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a14da3ee-a731-4282-be9d-407473517470) (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](https://list.essentialmeds.org/) (World Health Organization, 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=M03AC03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/pharmacology/vecuronium/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/vecuronium/