Sugammadex


Generic Medicine Info
Indications and Dosage
Intravenous
Reversal of neuromuscular blockade
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.
Renal Impairment
Haemodialysis patients: Contraindicated.
CrCl (mL/min) Dosage
<30  Contraindicated.
Incompatibility
Physically incompatible w/ ondansetron, ranitidine, verapamil.
Contraindications
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

Chemical Structure Image
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)

Storage
Store at 25°C. Protect from light.
MIMS Class
Antidotes & Detoxifying Agents
ATC Classification
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.

Disclaimer: This information is independently developed by MIMS based on Sugammadex 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 © 2021 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