AHFS Class:

12:20.20 Neuromuscular Blocking Agents

Generic Name

• Vecuronium Bromide

Vecuronium bromide is available as a lyophilized cake or powder in vials containing 10 or 20 mg of the drug.³⁶⁶¹ The vials also contain citric acid anhydrous, mannitol, and dibasic sodium phosphate anhydrous.³⁶⁶¹ Sodium hydroxide and/or phosphoric acid also may be present to adjust the pH.³⁶⁶¹

Ten- and 20-mg vials can be reconstituted with 10 and 20 mL, respectively, of a compatible diluent to yield a 1-mg/mL solution.³⁶⁶¹ When the lyophilized cake or powder is reconstituted with a compatible solution that does not contain an antimicrobial preservative (e.g., sterile water for injection), the vial is a single-use container; such vials should be stored under refrigeration, used within 24 hours, and the unused portion should be discarded.³⁶⁶¹ When the lyophilized cake or powder is reconstituted with bacteriostatic water for injection, which contains benzyl alcohol 0.9%, the vial is a multi-dose container; the reconstituted solution may be used for up to 5 days when stored at room temperature or under refrigeration.³⁶⁶¹ Reconstituted solutions prepared with bacteriostatic water for injection are not for use in newborns.³⁶⁶¹

pH

From 3.5 to 4.5.³⁶⁶¹

Osmolality

The osmolality of vecuronium bromide 4 mg/mL was determined to be 292 mOsm/kg.¹²³³

Vecuronium bromide is for intravenous use only.³⁶⁶¹ The drug may be administered by intravenous bolus injection or by intravenous infusion following dilution in a compatible diluent to a concentration of 0.1 or 0.2 mg/mL.³⁶⁶¹

Intact vials of vecuronium bromide should be stored at room temperature and retained in the original carton to protect from light.³⁶⁶¹ When the lyophilized cake or powder is reconstituted with sterile water for injection, the vial is a single-dose container; such vials should be stored under refrigeration, used within 24 hours, and the unused portion should be discarded.³⁶⁶¹ When the lyophilized cake or powder is reconstituted with bacteriostatic water for injection, the vial is a multiple-dose container; the solution may be used for up to 5 days when stored at room temperature or under refrigeration.³⁶⁶¹

pH Effects

Reconstituted solutions of vecuronium bromide have an acid pH and should not be combined with or administered simultaneously through the same needle or intravenous line as alkaline solutions (e.g., barbiturate solutions).³⁶⁶¹

Syringes

Vecuronium bromide 1 mg/mL in sterile water for injection and packaged in plastic syringes was found to be stable with no loss of drug for 21 days at room temperature and refrigerated.²⁷³⁵

Standardize 4 Safety

One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.

Table 1: Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Vecuronium³⁶³⁵; ³⁶³⁶

^a Paralytics are recommended to be administered as straight drug. This provides consistency between operating room and the ICU, and eliminates potential compounding errors.^b Babies weighing under 500 grams may require a lower concentration.

Solution Compatibility

Additive Compatibility

Drugs in Syringe Compatibility

Y-Site Injection Compatibility (1:1 Mixture)

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions September 12, 2024. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.