Usual Adult Dose for Reversal of Nondepolarizing Muscle Relaxants

Routine reversal (rocuronium or vecuronium):
4 mg/kg IV once if recovery has reached at least 1 to 2 posttetanic counts (PTC) and no twitch responses to train-of-four (TOF) stimulation
2 mg/kg IV once if recovery has reached reappearance of second twitch response to TOF stimulation

Immediate reversal (rocuronium only):
16 mg/kg IV once

Comments:

• Dosing is based on actual body weight; the recommended dose does not depend on the anesthetic regimen.
• Satisfactory recovery should be determined by skeletal muscle tone assessments and respiratory measurements in addition to the response to peripheral nerve stimulation.
• The efficacy of the 16 mg/kg dose following vecuronium-induced neuromuscular blockade has not been studied.

Uses: For the reversal of different levels of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults undergoing surgery.

Renal Dose Adjustments

Severe renal impairment: Use not recommended

• Mild to moderate renal impairment: Minimum wait time for readministration of rocuronium 0.6 mg/kg or vecuronium 0.1 mg/kg after reversal with sugammadex up to 4 mg/kg should be 24 hours; if a shorter waiting time is required, the rocuronium dose for a new neuromuscular blockade should be 1.2 mg/kg

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

The use of lower than recommended doses of sugammadex may increase the risk of neuromuscular blockade recurrence after initial reversal.

Minimum Wait Times for Re-Administration of Rocuronium or Vecuronium after Reversal with up to 4 mg/kg of Sugammadex:

• After 5 minutes may administer 1.2 mg/kg rocuronium*
• After 4 hours may administer 0.6 mg/kg of rocuronium or 0.1 mg/kg of vecuronium

*When rocuronium 1.2 mg/kg is given within 30 minutes after reversal with sugammadex, the onset of neuromuscular blockade may be delayed up to approximately 4 minutes and the duration of neuromuscular blockade may be shortened up to approximately 15 minutes

Minimum wait time for re-administration of rocuronium after sugammadex 16 mg/kg reversal is 24-hours.

If neuromuscular blockade is required before the recommended wait time has elapsed:

• A nonsteroidal neuromuscular blocking agent should be used.

Precautions

Safety and efficacy have not been established in patients younger than 17 years.

Consult WARNINGS section for additional precautions.

Dialysis

Not recommended

Other Comments

Administration advice:

• For IV use only
• Administer as a single IV bolus over 10 seconds into an existing IV line

Storage requirements:

• Protect from light
• If vial is not protected from light, the vial should be used within 5 days

Reconstitution/preparation techniques:

• Visually inspect for particulate matter and discoloration prior to administration
• Ensure the infusion line is adequately flushed between administration of this drug and other drugs; do not mix with other products except those listed as compatible.

IV compatibility:

• Compatible with: 0.9% sodium chloride; 5% dextrose; 5% dextrose in 0.9% sodium chloride; 0.45% sodium chloride and 2.5% dextrose; isolyte P with 5% dextrose; Ringer's lactate solution; Ringer's solution
• Physically incompatible with: verapamil; ondansetron; ranitidine

General:

• This drug should be administered by trained healthcare providers familiar with neuromuscular blocking agents and neuromuscular block reversal agents.
• This drug should not be used to reverse blockade induced by agents other than rocuronium or vecuronium.
• This drug has not been studied for use in the ICU.

Monitoring:

• Monitor ventilation and maintenance of a patent airway from time of administration until complete recovery of neuromuscular function.
• Monitor for hemodynamic changes during and after reversal of neuromuscular blockade.

Patient advice:

• Female patients of reproductive potential using hormonal contraceptive should be instructed to use additional, non-hormonal methods of contraception for the 7 days following treatment with this drug.