Rocuronium bromide


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Facilitate endotracheal intubation; Muscle relaxant in general anaesth; Facilitate mechanical ventilation in intensive care Initial: 0.6 mg/kg by inj. Maintenance: 0.15 mg/kg by inj or by infusion at 0.3-0.6 mg/kg/hr.
Dosage Details
Intravenous
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.
Child: Same as adult dose.
Elderly: Maintenance: 0.075-1 mg/kg.
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.
Incompatibility
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
MonitoringParameters
Monitor heart rate, BP, twitch response, assisted ventilation status.
Overdosage
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.
Action
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.
Chemical Structure

Chemical Structure Image
Rocuronium bromide

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)

Storage
Store between 2-8°C. Protect from light.
ATC Classification
M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
References
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.

Disclaimer: This information is independently developed by MIMS based on Rocuronium bromide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in