<p>Like other neuromuscular blocking agents, Vecuronium should only be administered by, or under supervision of, experienced clinicians who are familiar with the action and use of these agents.<br />
<br />
Like with other neuromuscular blocking agents, the dosage of Vecuronium should be individualised in each patient. The anaesthetic method used, the expected duration of surgery, the possible interaction with other medicines that are administered before or during anaesthesia and the condition of the patient should be taken into account when determining the dose. The use of an appropriate neuromuscular monitoring technique is recommended to monitor neuromuscular block and recovery.<br />
<br />
Inhalational anaesthetics do potentiate the neuromuscular blocking effects of Vecuronium. This potentiation however, becomes clinically relevant in the course of anaesthesia, when the volatile agents have reached the tissue concentrations required for this interaction. Consequently, adjustments with Vecuronium should be made by administering smaller maintenance doses at less frequent intervals or by using lower infusion rates of Vecuronium during long lasting procedures (longer than 1 hour) under inhalational anaesthesia.<br />
<br />
In adult patients the following dosage recommendations may serve as a general guideline for tracheal intubation and muscle relaxation for short to long lasting surgical procedures.<br />
<br />
Tracheal intubation: The standard intubating dose during routine anaesthesia is 0.08 to 0.1 mg vecuronium bromide per kg body weight, after which adequate intubation conditions are established within 90 to 120 seconds in nearly all patients.<br />
&nbsp;</p>

<p><strong>Dosages of Vecuronium for surgical procedures after intubation with suxamethonium:</strong></p>

<p>Recommended doses:</p>

<ul>
	<li>0.03 to 0.05 mg vecuronium bromide per kg body weight.</li>
	<li>If suxamethonium is used for intubation, the administration of Vecuronium should be delayed until the patient has clinically recovered from the neuromuscular block induced by suxamethonium.</li>
</ul>

<p>Maintenance dosing:</p>

<ul>
	<li>The recommended maintenance dose is 0.02 to 0.03 mg vecuronium bromide per kg body weight. These maintenance doses should best be given when twitch height has recovered to 25% of control twitch height.</li>
	<li>Dose requirements for administration of Vecuronium by continuous infusion.</li>
	<li>If Vecuronium is administered by continuous infusion, it is recommended to give a loading dose first (see &#39;Tracheal intubation&#39;) and, when neuromuscular block starts to recover, to start administration of Vecuronium by infusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 to 2 responses to train of four stimulation. In adults, the infusion rate required to maintain neuromuscular block at this level, ranges from 0.8 to 1.4 &micro;g vecuronium bromide/kg/min. For neonates and infants, see below. Repeat monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anaesthetic method used.</li>
</ul>

<p>&nbsp;</p>

<p><strong>Dosing in elderly patients</strong>:</p>

<ul>
	<li>The same intubation and maintenance doses as for younger adults (0.08-0.1 mg/kg and 0.02-0.03 mg/kg, respectively) can be used. However, the duration of action is prolonged in elderly compared to younger subjects due to changes in pharmacokinetic mechanisms. The onset time in elderly is similar to younger adults.</li>
	<li>In caesarean section and neonatal surgery the dose should not exceed 0.1 mg/kg.</li>
</ul>

<p>&nbsp;</p>

<p><strong>Dosing in paediatric patients:</strong></p>

<p>Because of the possible variation of the sensitivity of the neuromuscular junction, especially in neonates (up to 4 weeks) and probably in infants up to 4 months of age, an initial test dose of 0.01 to 0.02 mg vecuronium bromide per kg body weight followed by incremental doses until 90 to 95% depression of twitch response is achieved is recommended. In neonatal surgery the dose should not exceed 0.1 mg/kg. Dose requirements in neonates and infants (1-12 months) are the same as in adults. However, since the onset time of Vecuronium in these patients is considerably shorter than in adults and children, the use of high intubating doses in general is not required for early development of good intubating conditions.<br />
Since the duration of action and recovery time with Vecuronium is longer in neonates and infants than in children and adults, maintenance doses are required less frequently.<br />
<br />
Dose requirements in children (2-10 years) are higher. However, the same intubation and maintenance doses as for adults (0.08-0.1 mg/kg and 0.02-0.03 mg/kg, respectively) are usually sufficient. Since the duration of action is shorter in children, maintenance doses are required more frequently.<br />
<br />
Although there is very little information on dosage in adolescents, it is advised to use the same dose as in adults, based on the physiological development at this age.<br />
Dosing in overweight and obese patients<br />
When used in overweight or obese patients (defined as patients with a body weight of 30% or more above ideal body weight) doses should be reduced taking into account an ideal body weight.<br />
<br />
Higher doses: Should there be reason for selection of larger doses in individual patients; initial doses ranging from 0.15 mg up to 0.30 mg vecuronium bromide per kg body weight have been administered during surgery both under halothane and neurolept anaesthesia without adverse cardiovascular effects being noted as long as ventilation is properly maintained. The use of these high dosages of Vecuronium pharmacodynamically decreases the onset time and increases the duration of action.</p>

<p>&nbsp;</p>

<p><strong>Administration</strong></p>

<p>Vecuronium should be administered following reconstitution. Vecuronium is administered intravenously either as a bolus injection or as a continuous infusion</p>