Vecuronium and Nicardipine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nicardipine
Vecuronium
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Enhanced neuromuscular blockade
Interaction Deep Dive
Calcium blocking agents may enhance the neuromuscular blockade induced by nondepolarizing agents3 reducing required doses by up to 50% in a dose-dependent manner 1.
Why it happens (mechanism)
Additive pharmacodynamic effects; reduced clearance of vecuronium
Literature reports
2 reports — tap to read
a) Forty-seven patients in elective surgery volunteered for pharmacokinetic studies of the clinical interaction between niCARdipine and vecuronium. Patients were randomized to constant infusions of 0, 1, 2, or 3 mcg/kg/min niCARdipine, followed by the usual clinical application of vecuronium, with neuromuscular blockade electronically assessed and monitored to determine the dose of vecuronium needed to maintain muscle twitch at 10% of baseline for 1 hour. NiCARdipine induced a dose-related reduction in vecuronium requirements to, with reductions of approximately 50% at niCARdipine infusion rates above 2 mcg/kg/min. Compared to placebo infusion, during niCARdipine the required vecuronium dose was reduced from 730 mg/kg/min to 367 mg/kg/min, serum concentrations were reduced from 186 ng/mL to 120 ng/mL, and clearance was reduced from 3.9 mL/kg/min to 2.9 mL/kg/min. Vecuronium reversal by neostigmine was not affected 1.
b) A study involving 60 adult patients undergoing elective anesthesia were evaluated for onset and recovery of neuromuscular block produced by vecuronium using either post-tetanic count (PTC), or the first twitch of the train-of-four (TOF) (T1/T0) and TOF ratio (T4/T1) during continuous infusion of niCARdipine. Patients were allocated to one of four groups of 15 patients each: niCARdipine-PTC, niCARdipine-TOF, control-PTC, and control-TOF. niCARdipine 0.03 mg/kg was administered before vecuronium 0.1 mg/kg and a continuous infusion of niCARdipine was started immediately at a rate of 2mcg/kg/min in the niCARdipine-PTC and niCARdipine-TOF groups. Mean time from administration of vecuronium to onset of neuromuscular block was significantly shorter in the niCARdipine-PTC and niCARdipine-TOF groups as compared to that in the control-PTC and control-TOF groups. During infusion of niCARdipine, return of PTC1 and recovery of PTC or TOF ratio were not delayed, but times to return of T1, T2, T3 and T4, and recovery of T1/T0 were significantly longer than those in the control-TOF group. The onset of vecuronium-induced neuromuscular block was faster after bolus administration of niCARdipine 2.
Common questions
Can I take Vecuronium and Nicardipine together?
Enhanced neuromuscular blockade Always confirm with your pharmacist or prescriber before making any change.
How serious is the Vecuronium and Nicardipine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Vecuronium or Nicardipine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Kawabata K, Sumikawa K, Kamibayashi T, et al: Decrease in vecuronium infusion dose requirement by nicardipine in humans. Anesth Analg 1994; 79:1159-1164.
- Saitoh Y, Narumi Y, & Fujii Y: Post-tetanic and train-of-four responses during neuromuscular block produced by vecuronium and infusion of nicardipine. Br J Anaesth 1999; 83:340-342.
- Gilman AG, Goodman LS, Rall TW, et alGilman AG, Goodman LS, Rall TW, et al: Goodman and Gilman's The Pharmacologic Basis of Therapeutics, 7th. Macmillan Publishing Co. New York, NY, 1985.
Keep reading about Nicardipine
Keep reading about Vecuronium
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