Jeffrey L. Segar, MD and Sarah B. Tierney, PharmD
Peer Review Status: Internally Peer Reviewed 12/19/12

Agents should always be used in concert with adequate sedatives and analgesics

Non-depolarizing Agents Initial Dose (mg/kg) Onset of paralysis after administration (minutes) Pharmacokinetics
(Duration, dosing interval, protein binding)
Vecuronium IV: 0.1

(0.1 mg/kg/h for continuous infusion)
1-3 Duration (dose-dependent): 30-40 minutes
Dosing interval: 60-120 minutes
Protein binding: 60-80%
  • Metabolized by the liver. Decrease dose in event of liver dysfunction.
  • No cardiovascular effects or catecholamine or histamine release.
Pancuronium IV: 0.15 1-5 Duration (dose-dependent): 24 minutes
Dosing interval: 60-120 minutes
Protein binding: 87%
  • NOT RECOMMENDED FOR LONG TERM USE: Associated with prolonged paralysis and muscle atrophy after 1 week when given as intermittent doses.
  • Higher risk of tachycardia and hypertension compared to other non-depolarizing agents.
  • In premature infants, it is associated with joint contractures in hips and knees which do not persist after discontinuation of the drug.
  • Catecholamine/histamine release
Rocuronium IV: 0.4 – 0.6
Do not give IM
0.5-1.0 Duration: 20-120 minutes
Dosing interval: 10-30 minutes
Protein binding: 30%
  • Hepatic metabolism.  Decrease dose in event of severe hepatic disease. 
  • Negligible histamine release.
  • May be associated with increased pulmonary vascular resistance, caution is appropriate in patients with pulmonary hypertension.

*Depolarizing agents are not routinely recommended because they persist for a longer duration due to their resistance to acetylcholinesterase.
*Reversal of neuromuscular blockade: Neostigmine 0.04 – 0.08 mg/kg IV and atropine 0.02 mg/kg.


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