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Rocuronium

Class
Skeletal muscle relaxants
Subclass
Non-depolarizing neuromuscular blocking agents
Generic name
Rocuronium
Common formulations
Solution for injection
Indications for use
Labeled indications
Adults
•
Induction of neuromuscular blockade in patients undergoing surgery
Safety risks
Boxed warnings
Exacerbation of malignant hyperthermia
•
Use extreme caution with a personal or familial history of malignant hyperthermia.
Contraindications
A rocuronium bromide hypersensitivity or other neuromuscular blocking agent hypersensitivity
Warnings and precautions
Bronchospasm
•
Use caution with asthma or other pulmonary conditions.
Edema
•
Use caution with cardiac disease or other conditions that may be associated with a slower circulation time.
Exacerbation of reversal of neuromuscular blockade
•
Use caution in patients with a neuromuscular disease, such as myasthenia gravis or Lambert-Eaton syndrome.
Prolonged QT interval
•
Use caution with conditions that may increase the risk of QT prolongation or receiving other medications known to prolong the QT interval or cause electrolyte imbalances.
Pulmonary hypertension
•
Use caution with valvular heart disease.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-20 mL/min/1.73 m²
•
Use with extreme caution. Start at dose of Normal loading dose. Maximal dose of maintenance: 0.075-0.1 mg/kg; infusion: 0.3-0.4 mg/kg/hr. Monitor for signs of paralysis. Use the lowest possible dose in patients with GFR<20 mL/min, as at risk of prolonged paralysis.
eGFR < 10 mL/min/1.73 m²
•
Use with extreme caution. Start at dose of Normal loading dose. Maximal dose of maintenance: 0.075-0.1 mg/kg; infusion: 0.3-0.4 mg/kg/hr. Monitor for signs of paralysis. Use the lowest possible dose in patients with GFR<20 mL/min, as at risk of prolonged paralysis.
Renal replacement therapy
Continuous renal replacement
•
Use with extreme caution. Dose as in eGFR 10-20 mL/min/1.73 m². Start at a dose of Normal loading dose. Maximal dose of maintenance: 0.075-0.1 mg/kg; infusion: 0.3-0.4 mg/kg/hr. Monitor for paralysis. Use the lowest possible dose in patients with GFR<20 mL/min, as at risk of prolonged paralysis.
Intermittent hemodialysis
•
Use with extreme caution. Dose as in eGFR < 10 mL/min/1.73 m². Start at a dose of Normal loading dose. Maximal dose of maintenance: 0.075-0.1 mg/kg; infusion: 0.3-0.4 mg/kg/hr. Monitor for paralysis. Use the lowest possible dose in patients with GFR<20 mL/min, as at risk of prolonged paralysis.
Peritoneal dialysis
•
Use with extreme caution. Dose as in eGFR < 10 mL/min/1.73 m². Start at a dose of Normal loading dose. Maximal dose of maintenance: 0.075-0.1 mg/kg; infusion: 0.3-0.4 mg/kg/hr. Monitor for paralysis. Use the lowest possible dose in patients with GFR<20 mL/min, as at risk of prolonged paralysis.
Hepatic impairment
Any severity
•
Use with caution. - Individualize the dose to the needs of the patient.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. In animal studies, high-dose therapy caused acute respiratory dysfunction.
•
Teratogenicity was not observed.
•
There are no adequate and well-controlled studies with rocuronium in pregnant women.
Breastfeeding
Unlikely to have adverse effects in breastfed infants.
•
Acceptable for use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Unlikely to cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Common 1-10%
•
Hypertension, hypotension, tachycardia
Uncommon < 1%
•
Abnormal ECG, asthma, cardiac arrhythmias, generalized pruritus, hiccups, injection site reactions, nausea, skin rash, vomiting
Unknown frequency
•
Anaphylaxis, myopathy, paralysis, injection site pain, malignant hyperthermia
Interactions
Drug(s)
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