Adult: Routine reversal of rocuronium bromide- or vecuronium bromide-induced blockade: 4 mg/kg as a single dose if recovery has reached at least 1-2 post-tetanic counts (PTC) or 2 mg/kg as a single dose if spontaneous recovery has occurred up to at least the reappearance of T2. If neuromuscular blockade recurs post-operatively, a repeat dose of 4 mg/kg may be given. Immediate reversal of rocuronium bromide-induced blockade: 16 mg/kg as a single dose, given approx 3 minutes after administration of rocuronium bromide. All doses are given via bolus inj over 10 seconds. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines). Child: ≥2 years Routine reversal of rocuronium bromide- or vecuronium bromide-induced blockade: 4 mg/kg as a single dose if recovery has reached at least 1-2 PTC or 2 mg/kg as a single dose at the reappearance of T2. Treatment and dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Renal Impairment
Patient on dialysis: Not recommended.
CrCl (mL/min)
Dosage
<30
Not recommended.
Incompatibility
Incompatible with ondansetron, ranitidine and verapamil.
Special Precautions
Patient with or at risk for impaired haemostasis (e.g. coagulopathy), CV disease. Not intended for the reversal of blockade induced by nonsteroidal neuromuscular blockers (e.g. suxamethonium or benzylisoquinolinium compounds) or steroidal neuromuscular blockers other than rocuronium bromide or vecuronium bromide. Patient in ICU setting. Severe renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Recurrence of neuromuscular blockade; marked bradycardia and bradycardia with cardiac arrest. Cardiac disorders: Tachycardia. Gastrointestinal disorders: Abdominal pain, flatulence, xerostomia, nausea, vomiting. General disorders and administration site conditions: Pain, chills. Investigations: ECG abnormal. Musculoskeletal and connective tissue disorders: Myalgia, musculoskeletal pain. Nervous system disorders: Dizziness, headache, hypoaesthesia. Psychiatric disorders: Anxiety, depression, insomnia, restlessness. Respiratory, thoracic and mediastinal disorders: Cough. Skin and subcutaneous tissue disorders: Erythema, pruritus. Vascular disorders: Hypotension, hypertension. Potentially Fatal: Serious hypersensitivity reactions (e.g. anaphylaxis, anaphylactic shock).
Monitoring Parameters
Monitor neuromuscular stimulation; respiratory function (during recovery), ECG. Observe for signs of light anaesthesia (e.g. coughing, grimacing, movement or suckling of tracheal tube) since they may become apparent when neuromuscular blockade is reversed intentionally in the middle of anaesthesia. Assess for signs of hypersensitivity reactions.
Drug Interactions
Toremifene and fusidic acid may diminish the therapeutic effect of sugammadex. May reduce the efficacy of hormonal contraceptives. May enhance the effects of anticoagulants.
Lab Interference
May interfere with serum progesterone assay.
Action
Description: Mechanism of Action: Sugammadex, a modified γ-cyclodextrin, is a selective relaxant binding agent which forms a complex with the neuromuscular blocking agents rocuronium bromide or vecuronium bromide. This reduces the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction, resulting in the reversal of neuromuscular blockade induced by rocuronium bromide or vecuronium bromide. Onset: <3 minutes. Pharmacokinetics: Distribution: Volume of distribution: 11-14 L. Excretion: Via urine (95% as unchanged drug). Elimination half-life: Approx 2 hours.
Chemical Structure
Storage
Store between 15-30°C. Do not freeze. Protect from light.