Editing Vecuronium bromide (section)

== Mechanism of action ==
Vecuronium operates by competing for the cholinoceptors at the motor end plate, thereby exerting its muscle-relaxing properties, which are used adjunctively to general anesthesia.{{medcn|date=February 2023}} Under [[balanced anesthesia]], the time to recovery to 25% of control (clinical duration) is approximately 25 to 40 minutes after injection and recovery is usually 95% complete approximately 45 to 65 minutes after injection of an intubating dose.{{medcn|date=February 2023}} The neuromuscular blocking action of vecuronium is slightly enhanced in the presence of potent inhalation anesthetics.{{medcn|date=February 2023}} If vecuronium is first administered more than 5 minutes after the start of the inhalation of [[enflurane]], [[isoflurane]], or [[halothane]], or when a [[steady state]] has been achieved, the intubating dose of vecuronium may be decreased by approximately 15%.{{medcn|date=February 2023}}

Vecuronium has an active metabolite, 3-desacetyl-vecuronium, that has 80% of the effect of vecuronium. Accumulation of this metabolite, which is cleared by the kidneys, can prolong the duration of action of the drug, particularly when an infusion is used in a person with [[kidney failure]].<ref name="AHFS2016" />

Reversal of vecuronium can be accomplished by administration of [[sugammadex]] which is a γ-[[cyclodextrin]] which encapsulates vecuronium preventing it from binding to receptors.<ref>{{Cite web|url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022225lbl.pdf|archive-url=https://web.archive.org/web/20160207151530/http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022225lbl.pdf|url-status=dead|archive-date=7 February 2016|title=Bridion (sugammadex) Injection|last=U.S. Food and Drug Administration|access-date=1 December 2019}}</ref> Reversal can also be accomplished with [[neostigmine]] or other [[cholinesterase inhibitor]]s, but their efficacy is lower than that of sugammadex.<ref>{{cite journal | vauthors = Carron M, Zarantonello F, Tellaroli P, Ori C | title = Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials | journal = Journal of Clinical Anesthesia | volume = 35 | pages = 1–12 | date = December 2016 | pmid = 27871504 | doi = 10.1016/j.jclinane.2016.06.018 }}</ref>