Sugammadex

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.

• 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

Serious

• Anaphylaxis (0.3%), hypersensitivity reaction
• Bradycardia/Asystole (1-5%)
• 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