Adult: Routine reversal of rocuronium- or vecuronium-induced blockade: 2 mg/kg if recovery has occurred up to reappearance of T2 or 4 mg/kg if recovery has reached 1-2 post-tetanic counts (PTC); if neuromuscular blockade recurs post-op, a repeat dose of 4 mg/kg may be given. Immediate reversal of rocuronium-induced blockade: 16 mg/kg, given soon (approx 3 min) after admin of rocuronium. Doses are given via bolus inj over 10 seconds. Child: Routine reversal of rocuronium-induced blockade: 2-17 yr 2 mg/kg via bolus inj.
Hypersensitivity. CrCl <30 mL/min, including patients on haemodialysis.
Special Precautions
Patient w/ or at risk for impaired haemostasis (e.g. coagulopathy), CV disease. Not intended for reversal of blockade induced by nonsteroidal neuromuscular blockers (e.g. suxamethonium Cl, benzylisoquinolinium compd) or steroidal neuromuscular blockers other than rocuronium or vecuronium. Hepatic impairment (particularly if accompanied by coagulopathy or severe oedema).
Adverse Reactions
Significant: Recurrence of neuromuscular blockade. Nervous: Headache. CV: Hypotension. GI: Nausea, vomiting. Resp: Bronchospasm, cough. Others: Pain at inj site. Potentially Fatal: Serious hypersensitivity reactions (e.g. anaphylaxis, anaphylactic shock), marked bradycardia sometimes leading to cardiac arrest.
Monitoring Parameters
Monitor neuromuscular stimulation (e.g. post-tetanic counts and train-of-four) and resp function during recovery. Obtain haemostatic and coagulation parameters in select patients.
Drug Interactions
Toremifene (given on the same day of operation) and fusidic acid (given pre-op) may delay reversal time. Additive effect w/ K antagonists, LMWH, unfractioned heparin, dabigatran, and rivaroxaban in increasing aPTT and prothrombin time. May decrease the serum concentration of hormonal contraceptives.
Lab Interference
May interfere w/ serum progesterone assay.
Action
Description: Sugammadex is a modified γ-cyclodextrin that binds and forms a complex w/ the neuromuscular blocking agents rocuronium and vecuronium. This reduces the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction, thereby resulting to reversal of neuromuscular blockade. Onset: <3 min. Pharmacokinetics: Distribution: Volume of distribution: 11-14 L. Excretion: Mainly via urine (96% as unchanged drug). Elimination half-life: Approx 2 hr.
Chemical Structure
Sugammadex Source: National Center for Biotechnology Information. PubChem Database. Sugammadex, CID=6918584, https://pubchem.ncbi.nlm.nih.gov/compound/Sugammadex (accessed on Jan. 23, 2020)
V03AB35 - sugammadex ; Belongs to the class of antidotes. Used to reverse neuromuscular blockade caused by rocuronium or vecuronium.
References
Anon. Sugammadex. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/05/2017.Bridion Injection, Solution (Merck Sharp & Dohme Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/05/2017.Buckingham R (ed). Sugammadex Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/05/2017.Joint Formulary Committee. Sugammadex. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/05/2017.McEvoy GK, Snow EK, Miller J et al (eds). Sugammadex Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 02/05/2017.
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