A molecule of vecuronium


Vecuronium bromide is a very nice NMB. Unlike most other neuromuscular blocking agents, it has pretty much no side effects other than you not being able to move.? The only adverse thing is that when given via IV over a long period of time such as in the ICU, it sometimes likes to stick around in the body and cause residual paralysis that can last for at least a week (pretty epic stuff here).? It's metabolite 3-desacetyl vecuronium is also about 80% as active as the original molecule.? But if you're just giving it normally like for a surgery, you're fine.

It is a steroid-structured intermediate onset intermediate duration nondepolarizing neuromuscular blocking agent.

It was officially approved by the FDA on April 30, 1984, with the chemical formula C34H57N2O4.? It was first synthesized in 1973.

The ED95 for vecuronium is 0.05 mg/kg, intubating dose is 0.1 mg/kg. It comes in powdered form which is usually at a concentration of 1 mg/mL when reconstituted (meaning water is added to make it a solution).

Vecuronium's trade name is Norcuron. This is almost guaranteed to be because vecuronium is almost the same exact molecule as pancuronium except for the fact that its first nitrogen is missing a methyl group that pancuronium has. Therefore, it is monoquaternary instead of bis quaternary. The prefix "nor" when used in chemistry means next lower homologue, and it's most commonly stuck at the beginning of chemical names when the "nor" molecule is almost exactly like the original but missing a methyl group on the nitrogen. For example, norepinephrine is exactly like epinephrine except for the missing methyl group on its nitrogen atom, the methyl group simply being replaced by a hydrogen atom. In vecuronium's case, the methyl group isn't replaced by anything, but it could still be considered "nor"-pancuronium. Pancuronium actually used to be called "curon-b," so vecuronium literally is norcuron.

There also exists the molecule nor-norcuron, but it isn't a neuromuscular blocker, and it doesn't have a nice generic name. Instead, it's called (1S,2S,4S,5S,7S,10R,11S,13S,14R,15S)-5-(acetyloxy)-2,15-dimethyl-4,13-bis(piperidin-1-yl)tetracyclo[^{2,7}.0^{11,15}]heptadecan-14-yl acetate.

The end of it that has a regular nitrogen instead of a quaternary ammonium (N+) is also lipid soluble.? Vecuronium? is unstable in water (it's recommended that it be used within 5 days after preparing the solution).? Because of this, it's shipped as a lyophilized (freeze-dried) powder that is reconstituted before use rather than just being shipped as a solution? Overall though, it's still mainly a polar molecule since it's an ion.

Also, fun fact, in the 2007 movie Awake about anesthetic awareness, vecuronium is the main neuromuscular blocking agent given in the movie. It's stated at around 32:18.

"...What'd you use here?"

"Midazolam, fentanyl... a little vecuronium chaser."

It's also featured in an episode of the show ER.

"You gave him vec?! ... ... vecuronium, you gave him vecuronium."
"You were gonna give it to Rafe; you said it would 'knock him out.'" Part 1 , part 2

In the state of Oklahoma, vecuronium is used instead of pancuronium as the second drug in the lethal injection.