Burn Injury ≥20% Total Body Surface Area (see Burns): effect usually occurs several days after the burn injury and may persist for months after wound healing
Electrolyte Disturbance
Hypercalcemia (see Hypercalcemia): decreases the effect of neuromuscular junction antagonists
Immobilization
Neuromuscular Disease
Demyelinating Disease: decreases the effect of neuromuscular junction antagonists
Denervation: decreases the effect of neuromuscular junction antagonists
Muscle Trauma: decreases the effect of neuromuscular junction antagonists
Peripheral Neuropathy (see Peripheral Neuropathy): decreases the effect of neuromuscular junction antagonists
Disease States Which Enhance the Effects of Vecuronium
Acetylcholinesterase Inhbitors: acetylcholinesterase inhibitors antagonize the effect of vecuronium
Risk C: monitor therapy
Aminoglycosides (see Aminoglycosides): aminoglycosides enhance the effect of vecuronium
Risk C: monitor therapy
Calcium Channel Blockers (see Calcium Channel Blockers): calcium channel blockers enhance the paralytic effect of non-depolarizing neuromuscular junction antagonists
Risk C: monitor therapy
Cardiac Glycosides (Digoxin) (see Digoxin): neuromuscular junction antagonists may enhance the arrhythmogenic effect of cardiac glycosides
Risk C: monitor therapy
Colistin (Polymyxin E, Colistimethate Sodium) (see Colistin)
Risk D: consider therapy modification
Corticosteroids (see Corticosteroids): concomitant use of vecuronium and corticosteroids is associated with the development of neuropathy/myopathy
Risk D: consider therapy modification
Cyclosporine A (CSA) (see Cyclosporine A): cyclosporine A enhances the effect of neuromuscular junction antagonists
Risk C: monitor therapy
Inhalational Anesthetics: inhalational anesthetics enhance the effect of vecuronium
Risk C: monitor therapy
Ketorolac (see Ketorolac): ketorolac enhances the effect of neuromuscular junction antagonists (episodes of apnea have been reported with this combination)
Risk C: monitor therapy
Loop Diuretics (see Furosemide and Bumetanide): loop diuretics enhance the effect of neuromuscular junction antagonists
Risk C: monitor therapy
Piperacillin (see Piperacillin-Tazobactam): piperacillin enhances the effect of neuromuscular junction antagonists
Risk C: monitor therapy
Spironolactone (Aldactone) (see Spironolactone): spironolactone enhances the effect of neuromuscular junction antagonists
Risk C: monitor therapy
Tetracyclines (see Tetracyclines): tetracyclines enhance the effect of neuromuscular junction antagonists
Risk C: monitor therapy
Vancomycin (see Vancomycin): vancomycin enhances the effect of neuromuscular junction antagonists
Anaphylaxis/Anaphylactoid Reaction (see Anaphylaxis)
Epidemiology
Cross-Reactivity: cross-reactivity with other neuromuscular junction antagonists may occur (when anaphylaxis has previously occurred with other agent)
Relative Incidence of Anaphylaxis with Neuromuscular Junction Antagonists (in Australian Study from 2002-2011): Rocuronium (56% of cases) > Succinylcholine (21% of cases) > Vecuronium (11% of cases) (Br J Anaesth, 2013) [MEDLINE]
Cisatracurium Had the Lowest Prevalence of Cross-Reactivity in Patients with Known Anaphylaxis to Either Rocuronium or Vecuronium
Prolonged Weakness/Paralysis May Occur After Extended Use of Neuromuscular Junction Antagonists, Especially in Conjunction with Corticosteroids (see Neuromuscular Junction Antagonists and Corticosteroids)
Prolonged Paralysis
Epidemiology
Prolonged Weakness/Paralysis May Occur After Extended Use of Neuromuscular Junction Antagonists, Especially in Conjunction with Corticosteroids (see Neuromuscular Junction Antagonists and Corticosteroids)
Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med. 2002 Jan;30(1):142-56 [MEDLINE]
Current therapeutic uses, pharmacology, and clinical considerations of neuromuscular blocking agents for critically ill adults. Ann Pharmacother. 2011 Sep;45(9):1116-26. doi: 10.1345/aph.1Q004. Epub 2011 Aug 9 [MEDLINE]
Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011. Br J Anaesth. 2013 Jun;110(6):981-7. doi: 10.1093/bja/aes506. Epub 2013 Jan 18 [MEDLINE]