Rocuronium (rocuronium bromide)

Dosage of rocuronium bromide is expressed in terms of the salt. The dosage must be adjusted carefully according to individual requirements and response. The use of a peripheral nerve stimulator is recommended to accurately monitor the degree of muscle relaxation, determine the need for additional doses, determine the adequacy of spontaneous recovery or antagonism, and minimize the complications of overdosage if additional doses are administered.

A reduction in the dosage of rocuronium bromide may be required in patients receiving general anesthetics (e.g., enflurane, isoflurane) that potentiate its neuromuscular blocking activity. Potentiation is minimal when rocuronium is administered prior to these anesthetics.

Rocuronium bromide is administered IV only.

The initial (intubating) dose of rocuronium is administered by rapid IV injection; maintenance doses may be administered by intermittent IV injection or continuous IV infusion.

For continuous IV infusion, rocuronium bromide injection should be diluted to the desired concentration (e.g., 0.5, 1, or 5 mg/mL) in a compatible IV solution (0.9% sodium chloride, 5% dextrose, 5% dextrose and 0.9% sodium chloride, lactated Ringer's, or sterile water for injection). The infusion solution should be used within 24 hours of preparation. The rate of spontaneous neuromuscular recovery following discontinuance of the infusion is likely to be comparable to the rate of recovery following administration of comparable total doses administered via repetitive bolus injections.

Rocuronium bromide injection should be stored at 2-8degreesC prior to use; the drug should not be frozen. Once removed from refrigeration, the injection should be used within 60 days; opened vials of the drug should be used within 30 days. Following dilution, the infusion solution may be stored at room temperature for up to 24 hours.

If rocuronium is administered via the same infusion line as other drugs, ensure that the infusion line is adequately flushed between administration of rocuronium and administration of drugs for which compatibility with rocuronium has not been established. Rocuronium should not be mixed in the same syringe nor administered simultaneously through the same needle as an alkaline solution.

If extravasation occurs, administration of the drug should be discontinued immediately and restarted in another vein.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

*Known hypersensitivity to the drug or other neuromuscular blocking agents.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

The most common adverse effects of rocuronium observed in 2% of patients in clinical studies were transient hypotension and hypertension.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

Rocuronium has been evaluated in pediatric patients of all ages, including neonates, receiving sevoflurane and isoflurane/nitrous oxide anesthesia, and in pediatric patients 3 months to 14 years of age receiving halothane anesthesia. In pediatric patients receiving halothane anesthesia, transient increases in heart rate were observed following an intubating dose of rocuronium; this occurred mostly in patients who did not receive atropine.

Although not conclusively demonstrated, there is some evidence suggesting that concomitant use of general anesthetics with rocuronium can prolong the corrected QT (QTc) interval in pediatric patients.

The manufacturer states that rocuronium is not recommended for rapid sequence intubation in pediatric patients.

There are no adequate and well-controlled studies of rocuronium in pregnant women. In animal studies, teratogenicity was not observed. High-dose rocuronium was associated with acute symptoms of respiratory dysfunction in pregnant, conscious, non-ventilated rabbits and rats. The incidence of late embryonic death was increased in rats, most likely due to oxygen deficiency; this finding is not likely to be relevant for humans, since immediate mechanical ventilation of the intubated patient will prevent embryofetal hypoxia. Use rocuronium during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Rocuronium has been used in a limited number of pregnant women undergoing cesarean section. The manufacturer states that the drug is not recommended for rapid sequence induction in patients undergoing cesarean section because of possible poor or inadequate intubating conditions.

No information is available regarding the use of rocuronium in lactating patients.

Geriatric patients may exhibit a slightly prolonged median clinical duration of blockade (46, 62, and 94 minutes with rocuronium doses of 0.6, 0.9, and 1.2 mg/kg, respectively, under opioid/nitrous oxide/oxygen anesthesia). No differences in duration of neuromuscular blockade following maintenance doses of rocuronium were observed between geriatric patients and younger patients, but increased sensitivity of some older individuals cannot be ruled out.

Rocuronium has been evaluated in geriatric patients >=65 years of age in clinical studies. Geriatric patients exhibited a slightly slower onset and increased duration of neuromuscular blockade with rocuronium compared with younger adults; however, recovery times were not prolonged. Other clinical experience has not revealed age-related differences in response among geriatric patients receiving the drug; however, the possibility of greater sensitivity of some older patients cannot be ruled out.