Sugammadex: Difference between revisions
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==Administration== | ==Administration== | ||
*Type/Class: γ-cyclodextrin | *Type/Class: γ-cyclodextrin, [[antidote]] | ||
*Dosage Forms: | *Dosage Forms: | ||
**200mg/2mL (100mg/mL) | **200mg/2mL (100mg/mL) | ||
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==Adult Dosing== | ==Adult Dosing== | ||
'''IV bolus injection infused over 10 seconds via central or peripheral line with 16 mg/kg will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.''' | '''IV bolus injection infused over 10 seconds via central or peripheral line with 16 mg/kg will reverse a single 1.2 mg/kg dose of [[rocuronium]] in approximately 3 minutes.'''<ref>Abrishami A et al. "Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade". Cochrane Database of Systematic Reviews. 2009(4). CD007362. doi:10.1002/14651858.CD007362.pub2. PMID 19821409</ref> | ||
*4 mg/kg if patient has no twitch responses to train-of-four and emergent reverse is not needed | *4 mg/kg if patient has no twitch responses to train-of-four and emergent reverse is not needed | ||
*2mg/kg if patient has a second twitch after train of four and no emergent reversal is needed | *2mg/kg if patient has a second twitch after train of four and no emergent reversal is needed | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
* | *16 mg/kg for pediatric patients aged 2 years and older | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: There are no data on use in pregnant women | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: There are no data on use in pregnant women | ||
*[[Lactation risk categories|Lactation risk]]: Unknown | *[[Lactation risk categories|Lactation risk]]: Unknown | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: Unknown | *Adult: Unknown | ||
*Pediatric: Unknown | *Pediatric: Unknown | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
*Adult: Unknown | *Adult: Unknown | ||
*Pediatric: Unknown | *Pediatric: Unknown | ||
==Indications== | |||
*[[Rocuronium]] or [[vecuronium]] reversal | |||
==Contraindications== | ==Contraindications== | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
Adverse | Adverse effects are described in the anesthesia literature and the most serious side effect is in patients with a known hypersensitivity to Sugammadex<ref>Park J. Benefits and risks of sugammadex. Korean J Anesthesiol. 2015 Feb; 68(1): 1–2.</ref> | ||
===Serious=== | ===Serious=== | ||
*Anaphylaxis (0.3%) | *[[Anaphylaxis]] (0.3%), hypersensitivity reaction | ||
*Bradycardia (1-5%) | *Bradycardia/Asystole (1-5%) <ref>Bhavani, S. S. (2018). Severe bradycardia and asystole after sugammadex. British Journal of Anaesthesia, 121(1), 95–96.</ref> | ||
*[[Prolonged QT]] | |||
=== | ===Common=== | ||
*[[Nausea/vomiting]] | |||
*[[Headache]] | |||
*Coughing | *Coughing | ||
*Extremity pain | *Extremity pain | ||
*Parosmia | *Parosmia, hypoesthesia | ||
==Pharmacology== | ==Pharmacology== | ||
*Onset of action: reverses paralysis in ~3 minutes | |||
*Half-life: | *Half-life: 2h | ||
*Metabolism: | *Metabolism: | ||
*Excretion: | *Excretion: Renal | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
*Encapsulates [[rocuronium]] or [[vecuronium]] in plasma, reducing the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction and thereby reversing neuromuscular blockade | |||
==Comments== | ==Comments== | ||
*Sugammadex is only FDA approved for reversal for patients undergoing surgery. The drug has been used in Europe since 2008<ref>[http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/000885/WC500052309.pdf Assessment Report for Bridion. European Medicines Agency]</ref> | *Sugammadex is only FDA approved for reversal for patients undergoing surgery. The drug has been used in Europe since 2008<ref>[http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/000885/WC500052309.pdf Assessment Report for Bridion. European Medicines Agency]</ref> | ||
==See Also== | ==See Also== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Toxicology]] [[Category:Critical Care]] | |||
Latest revision as of 21:45, 16 April 2024
Administration
- Type/Class: γ-cyclodextrin, antidote
- Dosage Forms:
- 200mg/2mL (100mg/mL)
- 500mg/5mL (100mg/mL)
- Routes of Administration: IV
- Common Trade Names: Bridion
Adult Dosing
IV bolus injection infused over 10 seconds via central or peripheral line with 16 mg/kg will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.[1]
- 4 mg/kg if patient has no twitch responses to train-of-four and emergent reverse is not needed
- 2mg/kg if patient has a second twitch after train of four and no emergent reversal is needed
Pediatric Dosing
- 16 mg/kg for pediatric patients aged 2 years and older
Special Populations
- Pregnancy Rating: There are no data on use in pregnant women
- Lactation risk: Unknown
Renal Dosing
- Adult: Unknown
- Pediatric: Unknown
Hepatic Dosing
- Adult: Unknown
- Pediatric: Unknown
Indications
- Rocuronium or vecuronium reversal
Contraindications
- Allergy to class/drug and or prior documentation of hypersensitivity
Adverse Reactions
Adverse effects are described in the anesthesia literature and the most serious side effect is in patients with a known hypersensitivity to Sugammadex[2]
Serious
- Anaphylaxis (0.3%), hypersensitivity reaction
- Bradycardia/Asystole (1-5%) [3]
- Prolonged QT
Common
- Nausea/vomiting
- Headache
- Coughing
- Extremity pain
- Parosmia, hypoesthesia
Pharmacology
- Onset of action: reverses paralysis in ~3 minutes
- Half-life: 2h
- Metabolism:
- Excretion: Renal
Mechanism of Action
- Encapsulates rocuronium or vecuronium in plasma, reducing the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction and thereby reversing neuromuscular blockade
Comments
- Sugammadex is only FDA approved for reversal for patients undergoing surgery. The drug has been used in Europe since 2008[4]
See Also
References
- ↑ Abrishami A et al. "Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade". Cochrane Database of Systematic Reviews. 2009(4). CD007362. doi:10.1002/14651858.CD007362.pub2. PMID 19821409
- ↑ Park J. Benefits and risks of sugammadex. Korean J Anesthesiol. 2015 Feb; 68(1): 1–2.
- ↑ Bhavani, S. S. (2018). Severe bradycardia and asystole after sugammadex. British Journal of Anaesthesia, 121(1), 95–96.
- ↑ Assessment Report for Bridion. European Medicines Agency