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Vecuronium: Drug information

Vecuronium: Drug information
(For additional information see "Vecuronium: Patient drug information" and see "Vecuronium: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Experienced personnel:

This drug should be administered by adequately trained individuals familiar with its actions, characteristics, and hazards.

Pharmacologic Category
  • Neuromuscular Blocker Agent, Nondepolarizing
Dosing: Adult

Note: Dose to effect; doses will vary due to interpatient variability. Ensure adequate pain control and sedation prior to and during administration neuromuscular blockade to achieve deep sedation (SCCM [Murray 2016]).

Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation

Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation (as adjunct to general anesthesia): IV:

Tracheal intubation: IV: Initial: 0.08 to 0.1 mg/kg. Note: If intubation is performed using succinylcholine, the initial dose of vecuronium may be reduced to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia.

Pretreatment/priming: 10% of intubating dose given 3 to 5 minutes before intubating dose

Maintenance for continued surgical relaxation (only after return of neuromuscular function): Intermittent dosing: 0.01 to 0.015 mg/kg or continuous infusion of 0.8 to 1.2 mcg/kg/minute (0.048 to 0.072 mg/kg/hour).

Note: Use lower end of the dosing range when anesthesia is maintained with an inhaled anesthetic agent, with the redosing interval guided by monitoring with a peripheral nerve stimulator.

Intensive care unit paralysis

Intensive care unit paralysis (eg, use for up to 48 hours in patients with early ARDS with PaO2/FiO2 <150, to facilitate mechanical ventilation, shivering from therapeutic hypothermia) (off-label dosing): IV: Initial bolus dose: 0.08 to 0.1 mg/kg, then a continuous IV infusion of 0.8 to 1.7 mcg/kg/minute (0.048 to 0.102 mg/kg/hour); monitor depth of blockade every 1 to 2 hours initially until stable dose, then every 8 to 12 hours. Usual maintenance infusion dose range: 0.8 to 1.2 mcg/kg/minute (0.048 to 0.072 mg/kg/hour) (ACCM/SCCM/ASHP [Murray 2002]; Darrah 1989; Greenberg 2013; Rudis 1997)

Dosage adjustment: Adjust rate of administration in increments of 0.3 mcg/kg/minute (or 0.018 mg/kg/hour) or by 50% reductions of previous dose according to desired clinical response and possibly using peripheral nerve stimulation response. Discontinue infusion if neuromuscular function does not return (Rudis 1996; Rudis 1997).

Note: When possible, minimize depth and duration of paralysis. Stopping the infusion daily for some time until forced to restart based on patient condition is recommended to reduce post-paralytic complications (eg, acute quadriplegic myopathy syndrome [AQMS]) (ACCM/SCCM/ASHP [Murray 2002]; SCCM [Murray 2016]; Segredo 1992)

Intermittent bolus dosing: 0.1 to 0.2 mg/kg/dose; may be repeated when neuromuscular function returns (Hunter 1985); for shivering from therapeutic hypothermia may use 8 to 12 mg, repeated as needed to maintain adequate control (Bernard 2002; Nolan 2003; Polderman 2009)

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. However, patients with renal impairment do not experience clinically significant prolongation of neuromuscular blockade with vecuronium; however, in patients who are anephric, the clinical duration is prolonged.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage reduction may be necessary in patients with liver disease.

Dosing: Pediatric

(For additional information see "Vecuronium: Pediatric drug information")

Note: Dose to effect; doses will vary due to interpatient variability. Dosing in obese patients should be calculated using ideal body weight (Playfor 2007).

Neuromuscular blockade

Neuromuscular blockade:

Infants:

IV: 0.08 to 0.1 mg/kg/dose, repeat as needed (Martin 1999; Playfor 2007); Note: If intubation is performed using succinylcholine, the initial dose of vecuronium may be reduced to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia (manufacturer's labeling).

Continuous IV infusion: 0.8 to 1.7 mcg/kg/minute (0.05 to 0.1 mg/kg/hour) (Martin 1999; Playfor 2007).

Children and Adolescents:

IV: 0.08 to 0.1 mg/kg/dose, repeat as needed (Martin 1999; Playfor 2007); Note: If intubation is performed using succinylcholine, the initial dose of vecuronium may be reduced to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia. Children 1 to 10 years may require slightly higher initial doses and more frequent supplementation (manufacturer's labeling).

Continuous IV infusion: 0.8 to 2.5 mcg/kg/minute (0.05 to 0.15 mg/kg/hour) (Martin 1999; Playfor 2007).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling. Although patients with kidney impairment do not experience clinically significant prolongation of neuromuscular blockade with vecuronium, patients who are anephric may have a prolonged clinical duration; as a result, a lower initial dose should be considered.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling; however, dose reductions may be necessary in patients with liver disease.

Dosing: Older Adult

Refer to adult dosing. Dose selection should be cautious, at low end of dosage range, and titration should be slower to evaluate response.

Dosing: Obesity: Adult

The recommendations for dosing in patients with obesity are based upon the best available evidence and clinical expertise. Senior Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC.

Class 1, 2, or 3 obesity (BMI ≥30 kg/m2):

IV: Use ideal body weight for weight-based dosing calculations, then titrate to clinical effect. In patients with extreme obesity (eg, BMI ≥50 kg/m2), or when underdosing is a concern, consider using adjusted body weight for weight-based dosing calculations, then titrate to clinical effect; however, duration of action may be prolonged. Clinicians should not change dosing weight from one weight metric to another during therapy (ie, actual body weight to/from adjusted body weight or ideal body weight) (expert opinion). Refer to adult dosing for indication-specific doses.

Rationale for recommendations:

Nondepolarizing neuromuscular blocking agents (NMBA) are hydrophilic compounds with a small Vd; thus, distribution of vecuronium into adipose tissue is limited (Schwartz 1992). There are no studies evaluating the most appropriate weight metric in patients with obesity receiving sustained continuous infusions. Data with NMBAs in patients with obesity predominantly originate from studies evaluating either single bolus or incremental doses in patients undergoing surgical procedures. Studies where vecuronium was dosed using actual body weight have demonstrated prolonged recovery times in patients with obesity compared to patients who are normal weight or overweight, suggesting alternative weight-based metrics (eg, ideal body weight, lean body weight) may be preferred (Harrison 1989; Schwartz 1992; Suzuki 2006; Weinstein 1988).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous, as bromide:

Generic: 10 mg (1 ea); 20 mg (1 ea)

Solution Reconstituted, Intravenous, as bromide [preservative free]:

Generic: 10 mg (1 ea); 20 mg (1 ea)

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Intravenous, as bromide:

Generic: 10 mg ([DSC])

Administration: Adult

IV: For IV administration only; do not administer IM. Concentration of 1 mg/mL may be administered by rapid IV injection; may also be used for IV infusion in fluid-restricted patients.

Administration: Pediatric

Parenteral:

IV bolus: Administer undiluted (reconstituted solution at 1 mg/mL) by rapid direct injection.

Continuous IV infusion: Administer via an infusion pump.

Usual Infusion Concentrations: Adult

IV infusion: 10 mg in 100 mL (concentration: 0.1 mg/mL), 20 mg in 100 mL (concentration: 0.2 mg/mL), or 50 mg in 50 mL (concentration: 1 mg/mL) of D5W or NS

Usual Infusion Concentrations: Pediatric

IV infusion: 0.1 mg/mL, 0.2 mg/mL, 1 mg/mL

Use: Labeled Indications

Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation: As adjunct to general anesthesia to facilitate endotracheal intubation and to relax skeletal muscles during surgery or mechanical ventilation in adequately sedated ICU patients

Note: Neuromuscular blockade does not provide pain control, sedation, or amnestic effects. Appropriate analgesic and sedative mediations should be used before and during administration of neuromuscular blockade to achieve deep sedation.

Use: Off-Label: Adult

Acute respiratory distress syndrome; Shivering due to therapeutic hypothermia following cardiac arrest

Medication Safety Issues
Sound-alike/look-alike issues:

Vecuronium may be confused with valproate sodium, vancomycin

Norcuron may be confused with Narcan

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Other safety concerns:

According to the 2020 to 2021 ISMP targeted medication safety best practices for hospitals, neuromuscular blockers should be segregated, sequestered, and differentiated from all other medication wherever they are stored. This includes:

Only storing in places within the hospital that they are routinely used.

Placing in sealed boxes or in rapid-sequence intubation kits (preferred).

Limiting availability in automated dispensing cabinets to perioperative, labor and delivery, critical care, and emergency departments only.

Placing in separate lidded containers within the pharmacy refrigerator or other isolated pharmacy storage area.

Affixing an auxiliary label to clearly communicate respiratory paralysis will occur and ventilation required on all storage bins and/or automated dispensing pockets/drawers (exception anesthesia-prepared syringes) stating one of the following:

Warning: Causes Respiratory Arrest – Patient Must Be Ventilated.

Warning: Paralyzing Agent – Causes Respiratory Arrest.

Warning: Causes Respiratory Paralysis – Patient Must Be Ventilated.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

<1%, postmarketing, and/or case reports: Bradycardia, circulatory shock, edema, flushing, hypersensitivity reaction (including erythema, hypotension, tachycardia, urticaria), pruritus, skin rash

Contraindications

Hypersensitivity to vecuronium or any component of the formulation

Documentation of allergenic cross-reactivity for neuromuscular blockers is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: Severe anaphylactic reactions have been reported with vecuronium use; some life-threatening and fatal. Appropriate emergency treatment (including epinephrine 1 mg/mL) should be immediately available during use. Use caution in patients with previous anaphylactic reactions to other neuromuscular-blocking agents.

• Prolonged paralysis: Some patients may experience delayed recovery of neuromuscular function after administration (especially after prolonged use). Other factors associated with delayed recovery should be considered (eg, corticosteroid use, disease-related conditions).

Disease-related concerns:

• Burn injury: Resistance may occur in burn patients (≥20% of total body surface area), usually several days after the injury, and may persist for several months after wound healing (Han 2009).

• Conditions that may antagonize neuromuscular blockade (decreased paralysis): Respiratory alkalosis, hypercalcemia, demyelinating lesions, peripheral neuropathies, denervation, and muscle trauma may result in antagonism of neuromuscular blockade (ACCM/SCCM/ASHP [Murray 2002]; Greenberg 2013; Miller 2010; Naguib 2002).

• Conditions that may potentiate neuromuscular blockade (increased paralysis): Electrolyte abnormalities (eg, severe hypocalcemia, severe hypokalemia, hypermagnesemia), neuromuscular diseases, metabolic acidosis, respiratory acidosis, Eaton-Lambert syndrome, and myasthenia gravis may result in potentiation of neuromuscular blockade (Greenberg 2013; Miller 2010; Naguib 2002).

• Hepatic impairment: Use with caution in patients with hepatic impairment; clinical duration may be prolonged.

• Renal impairment: In general, patients with renal impairment do not experience clinically significant prolongation of neuromuscular blockade with vecuronium; however, in patients who are anephric, the clinical duration may be prolonged.

• Respiratory disease: Use with caution in patients with underlying respiratory disease.

Special populations:

• Older adult: Use with caution in the elderly, effects and duration are more variable; dosage reduction may be considered.

• Immobilized patients: Resistance may occur in patients who are immobilized.

• Pediatric: Children 1-10 years of age may require slightly higher initial doses and slightly more frequent supplementation.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Diluent (bacteriostatic water for injection) contains benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

Other warnings/precautions:

• Appropriate use: Maintenance of an adequate airway and respiratory support is critical. All patients should receive eye care including liberal use of lubricating drops, gel, or ointment and eyelids should remain closed during continuous neuromuscular blockade to protect against damage to the cornea (ulceration and drying).

• Experienced personnel: [US Boxed Warning]: Should be administered by adequately trained individuals familiar with its use.

• Risk of medication errors: Accidental administration may be fatal. Confirm proper selection of intended product, store vial so the cap and ferrule are intact and the possibility of selecting the wrong product is minimized, and ensure that the intended dose is clearly labeled and communicated, when applicable.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Aminoglycosides: May enhance the therapeutic effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bacitracin (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Botulinum Toxin-Containing Products: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bromperidol: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Calcium Channel Blockers: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

CarBAMazepine: May decrease the serum concentration of Vecuronium. Risk C: Monitor therapy

Cardiac Glycosides: Neuromuscular-Blocking Agents may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy

Clindamycin (Topical): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Colistimethate: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of these products. Monitor for deeper, prolonged neuromuscular-blocking effects (respiratory paralysis) in patients receiving concomitant neuromuscular-blocking agents and colistimethate. Risk D: Consider therapy modification

Corticosteroids (Systemic): Neuromuscular-Blocking Agents (Nondepolarizing) may enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Management: If concomitant therapy is required, use the lowest dose for the shortest duration to limit the risk of myopathy or neuropathy. Monitor for new onset or worsening muscle weakness, reduction or loss of deep tendon reflexes, and peripheral sensory decriments Risk D: Consider therapy modification

CycloSPORINE (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Dantrolene: May enhance the neuromuscular-blocking effect of Vecuronium. Risk C: Monitor therapy

Fosphenytoin-Phenytoin: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may decrease the serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Inhalational Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Management: When initiating a non-depolarizing neuromuscular blocking agent (NMBA) in a patient receiving an inhalational anesthetic, initial NMBA doses should be reduced 15% to 25% and doses of continuous infusions should be reduced 30% to 60%. Risk D: Consider therapy modification

Ketorolac (Nasal): May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Risk C: Monitor therapy

Ketorolac (Systemic): May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Risk C: Monitor therapy

Lincosamide Antibiotics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Lithium: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Local Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Loop Diuretics: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Magnesium Salts: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

MetroNIDAZOLE (Systemic): May enhance the neuromuscular-blocking effect of Vecuronium. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Ornidazole: May enhance the neuromuscular-blocking effect of Vecuronium. Risk C: Monitor therapy

Pholcodine: May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents. Specifically, anaphylaxis has been reported. Risk C: Monitor therapy

Piperacillin: May enhance the neuromuscular-blocking effect of Vecuronium. Risk C: Monitor therapy

Polymyxin B: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of neuromuscular-blocking agents and polymyxin B. If concomitant use cannot be avoided, monitor for deeper, prolonged neuromuscular-blocking effects (eg, respiratory paralysis) in patients receiving this combination. Risk D: Consider therapy modification

Procainamide: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

QuiNIDine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

QuiNINE: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk X: Avoid combination

Tetracyclines: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Thiazide and Thiazide-Like Diuretics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Trimebutine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Vancomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Pregnancy Considerations

The pharmacokinetics of vecuronium are altered during pregnancy. Use in cesarean section has been reported; umbilical venous concentrations were 11% of maternal values at delivery.

Breastfeeding Considerations

It is not known if vecuronium is present in breast milk. The manufacturer recommends that caution be exercised when administering vecuronium to breastfeeding women.

Monitoring Parameters

Vital signs (heart rate, blood pressure, respiratory rate); degree of muscle paralysis (eg, presence of spontaneous movement, ventilator asynchrony, shivering, and consider use of a peripheral nerve stimulator with train of four monitoring along with clinical assessments)

In the ICU setting, prolonged paralysis and generalized myopathy, following discontinuation of agent, may be minimized by appropriately monitoring degree of blockade.

Mechanism of Action

Blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization

Pharmacokinetics

Onset of action:

Good intubation conditions: Within 2 to 3 minutes (Price 2012).

Maximum neuromuscular blockade: Within 3 to 5 minutes.

Duration: Under balanced anesthesia (time to recovery to 25% of control): 25 to 40 minutes; recovery 95% complete ~45 to 65 minutes after injection of intubating dose; hypothermia may prolong the duration of action.

Distribution: Vd: 0.3 to 0.4 L/kg.

Protein binding: 60% to 80%.

Metabolism: Active metabolite: 3-desacetyl vecuronium (1/2 the activity of parent drug).

Half-life, elimination:

Infants: 65 minutes.

Children: 41 minutes.

Healthy adult surgical patients and renal failure patients undergoing transplant surgery: 65 to 75 minutes; Late pregnancy: 35 to 40 minutes.

Half-life, distribution: Adults: 4 minutes.

Excretion: Primarily feces (35% to 50%); urine (15% to 50% as unchanged drug and metabolites) (Price 2012).

Pricing: US

Solution (reconstituted) (Vecuronium Bromide Intravenous)

10 mg (per each): $4.75 - $10.20

20 mg (per each): $9.72 - $20.40

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Curon (BD);
  • Galaren (AR);
  • Muscuvec (EG);
  • Neovec (ET, LK);
  • Nodescron (CR, DO, GT, HN, NI, PA, SV);
  • Nodescrón (MX);
  • Nor Q (BD);
  • Norcuron (AE, AU, BG, CL, CN, CY, DK, EE, FR, GB, GR, HK, HN, ID, IL, IN, IQ, IR, IT, JO, KR, LU, LY, MT, MX, NZ, OM, PE, PK, PT, SA, SI, SK, SY, TH, TR, VE, VN, YE, ZA);
  • Survec (BD, LK);
  • Vecur (VE);
  • Vecural (PY, UY);
  • Vecure (AU);
  • Vecuron (AR, BD, BR, EG, PH)


For country code abbreviations (show table)
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