Parenteral Manual

Sugammadex

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
BRIDION
Classification: 
Reversal agent for nondepolarizing neuromuscular blocking (NMB) agents
Original Date: 
June 2016
Revised Date: 
September 2016
Indications: 
  • 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
Compatibility: 

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

-  Incompatible:  ondansetron, ranitidine, verapamil

Administration: 

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

SC NO
IM NO
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

 

Dosage: 

(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
Notes: 
  • Not recommended for patients with severe renal impairment and patients on dialysis

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