Parenteral Manual


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Alternate Name(s): 
Reversal agent for nondepolarizing neuromuscular blocking (NMB) agents
Original Date: 
June 2016
Revised Date: 
September 2016
  • Reversal of moderate to deep neuromuscular blockade induced by rocuronium or vecuronium in patients undergoing surgery
  • Emergency reversal (within 3 minutes) of rocuronium administration in difficult to intubate patients

The safety and efficacy in pediatric patients (less than 18 years of age) has not been established

Reconstitution and Stability: 
  • Available as 100 mg/mL injection solution.  No reconstitution or further dilution necessary.  May be diluted with 0.9% NS to 25 mg/mL for children less then 2 years
  • Stable between 15 - 30 C
  • Protect from light - use vial within 5 days when not protected from light

-  Solutions Compatible: 0.9% NaCl, D5W, D5W/0.9%NaCl, Ringer's lactate, Ringer's solution

-  Incompatible:  ondansetron, ranitidine, verapamil


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

YES - rapid bolus within 10 seconds

Flush line with 0.9% NaCl between sugammadex & other drugs

IV Intermittent Infusion NO
IV Continuous Infusion NO



(For neonatal dosages, refer to Neonatal IV Drug Manual.)

-  To reverse rocuronium or vecuronium induced NMB to recovery defined as a TOF (T1/T4 ratio of 0.9:

  • Moderate blockade:  2 mg/kg/dose* IV
  • Deep blockade:  4 mg/kg/dose* IV

* Based on actual body weight. Dosing and timing of sugammadex administration should be based on monitoring for twitch responses and the extent of spontaneous recovery that has occurred.


- Urgent Reversal of neuromuscular blockade following administration of a single dose of 1.2 mg/kg of rocuronium for intubation:

  •  16 mg/kg/dose IV      - NOT studied in the pediatric population for this indication.
Potential hazards of parenteral administration: 
  • Hypersensitivity reactions: anaphylaxis or anaphylactoid reactions, may occur on first or subsequent exposure.
  • Cardiovascular: marked bradycardia within minutes after administration. Bradycardia with cardiac arrest has occurred. For clinically significant bradycardia, treat with anti-cholinergic agents such as atropine.
  • Haematologic: transient (<1 hour) increased in coagulation parameters (aPTT, PT, INR)
  • Adverse Effects Greater than 10%: hypotension, headache, nausea and vomiting, pain at site of injection
  • Adverse Effects 1– 10%: Prolonged QT interval on ECG, bradycardia, tachycardia
  • Not recommended for patients with severe renal impairment and patients on dialysis

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