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Rocuronium Bromide

Pronouncation: (row-kuhr-OH-nee-uhm BROE-mide)
Class: Nondepolarizing neuromuscular blocker

Trade Names:
Zemuron
- Injection 10ߙmg/mL

Pharmacology

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Binds competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.

Pharmacokinetics

Distribution

Rapid distribution t _½ is 1 to 2ߙmin and the slower distribution t _½ is 14ߙto 18ߙmin. Plasma protein binding is approximately 30%.

Indications and Usage

As an adjunct to general anesthesia for inpatients and outpatients to facilitate both rapid sequence and routine tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Contraindications

Standard considerations.

Dosage and Administration

Use of a peripheral nerve stimulator is recommended to monitor drug response and determine the need for additional relaxant and adequacy of spontaneous recovery or antagonism.

Continuous Infusion
Adults

IV 0.01 to 0.012 mg/kg per min initiated only after early evidence of spontaneous recovery from the intubating dose.

Individualization of Dosage
Children

IV 0.6 mg/kg as an initial dose in children under halothane anesthesia produces excellent to good intubating conditions within 1 min.

Maintenance dose

0.075 to 0.125 mg/kg administered at 25% recovery of control T ₁ provides relaxation for 7 to 10 min.

Elderly (65 yr of age and older)

IV exhibited slightly prolonged median clinical duration under opioid/nitrous oxide/oxygen anesthesia following doses of 0.6, 0.9, and 1.2 mg/kg, respectively.

Maintenance dose

0.1 to 0.15 mg/kg administered at 25% recovery of T ₁ .

Maintenance
Adults

IV 0.1, 0.15, and 0.2 mg/kg administered at 25% recovery of control T ₁ (defined as 3 twitches of train-of-four).

Rapid Sequence Intubation
Adults

IV 0.6 to 1.2 mg/kg provides excellent to good intubating conditions in most patients in less than 2 min.

Tracheal Intubation
Adults

IV 0.6 mg/kg as a recommended initial dose. Good intubation conditions usually occur within 2 min.

Storage/Stability

Store vials in refrigerator (36° to 46°F). Do not freeze. May be removed from refrigerator and stored at controlled room temperature (less than 77°F), but injection must be used within 60 days. Once vial has been opened, use within 30 days.

Drug Interactions

Antibiotics (eg, aminoglycoside antibiotics [eg, kanamycin], bacitracin, clindamycin, lincomycin, polymyxins, sodium colistimethate, tetracyclines), lithium, local anesthetics, magnesium salts, procainamide, quinidine

May enhance the neuromuscular blocking action of rocuronium.

Carbamazepine, phenytoin

Resistance to neuromuscular blocking action of rocuronium may occur.

Nitrous oxide/oxygen with either enflurane or isoflurane

May prolong the clinically effective duration of action of initial and maintenance doses of rocuronium and decrease the required infusion rate.

Succinylcholine

Time of onset of max block following rocuronium may be faster with prior administration of succinylcholine.

Incompatibility

Should not be mixed with alkaline solutions (eg, barbiturates) in the same syringe or administered simultaneously during IV infusion through the same needle.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Arrhythmia, abnormal ECG, tachycardia, transient hypotension and hypertension (less than 1%).

Dermatologic

Rash, injection site edema, pruritus (less than 1%).

GI

Nausea, vomiting (less than 1%).

Respiratory

Asthma (bronchospasm, wheezing, rhonchi), hiccup (at least 1%).

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy has not been established in children less than 3 mo of age. Use in pediatric patients less than 3 mo or greater than 14 yr of age have not been studied.

Hypersensitivity

Rare, severe, or life-threatening anaphylactic reactions have been reported.

Hepatic Function

Use with caution.

Special Risk Patients

May have profound effect in patients with neuromuscular disease (eg, myasthenia gravis). Patients with burns, hemiparesis, or paraparesis may have resistance to rocuronium.

Administration

Under the supervision of experienced clinicians who are familiar with rocuronium action and complications. Personnel and facilities for resuscitation and life support and an antagonist of rocuronium should be immediately available.

Malignant hyperthermia

May occur.

Onset time

May be delayed in patients with slower circulation time (eg, CV disease).

Pulmonary hypertension

Because rocuronium may be associated with increased pulmonary vascular resistance, use with caution in patients with pulmonary hypertension or valvular heart disease.

Tolerance

Tolerance may develop during chronic administration in the intensive care unit.

Overdosage

Symptoms

Prolonged neuromuscular block.

Patient Information

Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a health care setting.
Reassure patient, family, or caregiver that breathing will be closely monitored and supported while medication is being administered and that breathing and muscle function will return to normal after medication has been discontinued.