Rocuronium bromide

Intravenous
Facilitate endotracheal intubation, Facilitate mechanical ventilation in intensive care, Muscle relaxant in general anaesthesia

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.

Maintenance: 0.075-1 mg/kg by inj or 3-4 mg/kg/hr by infusion.

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.

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.

Changes in vital signs, prolonged neuromuscular block, myopathy; inj site pain/reaction.
Potentially Fatal: Anaphylaxis.

IV/Parenteral: C

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.

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.

Description: 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.
Pharmacokinetics:
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.

Source: National Center for Biotechnology Information. PubChem Database. Rocuronium bromide, CID=441351, https://pubchem.ncbi.nlm.nih.gov/compound/Rocuronium-bromide (accessed on Jan. 23, 2020)

Store between 2-8°C. Protect from light.

Neuromuscular Blocking Agents

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. https://online.lexi.com. Accessed 19/08/2015.

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

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