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.[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
  • No approved dosing or usage

Special Populations

Renal Dosing
  • Adult: Unknown
  • Pediatric: Unknown

Hepatic Dosing
  • Adult: Unknown
  • Pediatric: Unknown

Indications

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

Common

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
  1. 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
  2. Park J. Benefits and risks of sugammadex. Korean J Anesthesiol. 2015 Feb; 68(1): 1–2.
  3. Bhavani, S. S. (2018). Severe bradycardia and asystole after sugammadex. British Journal of Anaesthesia, 121(1), 95–96.
  4. Assessment Report for Bridion. European Medicines Agency
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