Rocuronium bromide

Generic Medicine Info
Indications and Dosage
Facilitate endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 0.6 mg/kg by inj. Higher doses of 1 mg/kg may be used for intubation during rapid sequence induction of anaesthesia. Maintenance: 0.15 mg/kg by inj (may reduce to 0.075-1 mg/kg for prolonged inhalational anaesthesia) or by infusion at 0.3-0.6 mg/kg/hr.
Elderly: Maintenance: 0.075-1 mg/kg.
Child: Same as adult dose.
Special Patient Group
Obese patients (≥130% of ideal body wt): Reduce dose, based on ideal body wt. Biliary tract disease: Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.
Renal Impairment
Maintenance: 0.075-1 mg/kg by inj or 3-4 mg/kg/hr by infusion.
Hepatic Impairment
Maintenance: 0.075-1 mg/kg by inj or 3-4 mg/kg/hr by infusion.
Alkaline soln; amphotericin, amoxicillin, azathioprine, cefazolin, cloxacillin, dexamethasone, diazepam, enoximone, erythromycin, famotidine, furosemide, hydrocortisone Na succinate, insulin, intralipid, methohexital, methylprednisolone, prednisolone Na succinate, thiopental, trimethoprim, vancomycin. Y-site: Micafungin.
Special Precautions
Patient w/ biliary tract disease, neuromuscular disease, previous poliomyelitis, burn injury, severe electrolyte disturbances, Eaton-Lambert syndrome, myasthenia gravis, CV disease, resp disease, pulmonary HTN; obese patients. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Changes in vital signs, prolonged neuromuscular block, myopathy; inj site pain/reaction.
Potentially Fatal: Anaphylaxis.
IV/Parenteral: C
Monitoring Parameters
Monitor heart rate, BP, twitch response, assisted ventilation status.
Symptoms: Prolonged neuromuscular blockade. Management: Maintain patent airway, controlled ventilation and adequate sedation. May administer an anticholinesterase agent in conjunction w/ an appropriate anticholinergic agent once recovery from neuromuscular block is observed.
Drug Interactions
Increased effect w/ halogenated volatile anaesth (e.g. enflurane, isoflurane), antibiotics (e.g. aminoglycoside, lincosamide and polypeptide antibiotics, acylamino-penicillin antibiotics), diuretics, quinidine, quinine, Mg and lithium salts, Ca channel blockers, local anaesth, acute admin of phenytoin or β-blocking agents, corticosteroid (long-term use) and after intubation w/ suxamethonium. Decreased effect w/ Ca chloride and KCl, protease inhibitors (e.g. gabexate, ulinastatin), chronic admin of phenytoin or carbamazepine.
Mechanism of Action: Rocuronium competes for nicotinic cholinoreceptors at the motor end-plate, resulting to neuromuscular blockade.
Onset: Good intubation conditions: W/in 1-2 min. Max neuromuscular blockade: W/in 4 min.
Duration: Approx 30-50 min.
Distribution: Volume of distribution: Approx 0.25 L/kg. Plasma protein binding: Approx 30%.
Metabolism: Minimally hepatic, converted to 17-desacetylrocuronium (main metabolite).
Excretion: Via urine (up to 40% w/in 24 hr) and bile. Elimination half-life: Approx 1.2-1.4 hr.
Chemical Structure

Chemical Structure Image
Rocuronium bromide

Source: National Center for Biotechnology Information. PubChem Database. Rocuronium bromide, CID=441351, (accessed on Jan. 23, 2020)

Store between 2-8°C. Protect from light.
MIMS Class
Neuromuscular Blocking Agents
ATC Classification
M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
Anon. Rocuronium. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. Accessed 19/08/2015.

Buckingham R (ed). Rocuronium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. Accessed 18/08/2015.

Rocuronium Bromide Injection, Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. Accessed 18/08/2015.

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