Generic
Rocuronium Bromide
2 brands available in the market
At a glance
Rocuronium Bromide is a non-depolarizing muscle relaxant used during general anesthesia to facilitate tracheal intubation and provide skeletal muscle relaxation during surgery. It is also used in the ICU to facilitate intubation and mechanical ventilation.
Description
Rocuronium Bromide is a steroidal neuromuscular blocking agent that competes for nicotinic cholinergic receptors at the motor end-plate. It prevents acetylcholine binding, inhibits depolarization, and blocks calcium release, resulting in muscle relaxation.
Indications
- To facilitate tracheal intubation during routine anesthesia
- To provide skeletal muscle relaxation during surgery
- As an adjunct in the ICU to facilitate intubation and mechanical ventilation
Therapeutic class
Non-depolarizing Muscle Relaxants
Pharmacological class
Neuromuscular Blocking Agent
Pharmacology
Rocuronium competes with acetylcholine for nicotinic receptors at the motor end-plate, preventing depolarization and muscle contraction. It inhibits calcium ion release and is antagonized by acetylcholinesterase inhibitors like neostigmine.
Mechanism of action
Blocks nicotinic receptors at the motor end-plate to relax skeletal muscles.
Dosage
Adult Dose (IV):
- Routine intubation: 0.6 mg/kg (intubation within 60 seconds)
- Rapid sequence intubation: 1.0 mg/kg (intubation within 60 seconds) or 0.6 mg/kg (at 90 seconds)
- Maintenance: 0.15 mg/kg (0.075-0.1 mg/kg with inhalational anesthesia)
- Continuous infusion: Loading 0.6 mg/kg; then 0.3-0.6 mg/kg/hr (IV anesthesia) or 0.3-0.4 mg/kg/hr (inhalational)
Pediatric (1-14 years):
- Similar sensitivity to adults under halothane; faster onset and shorter duration in children
Elderly & Hepatic/Renal Failure:
- Intubation: 0.6 mg/kg; Maintenance: 0.075-0.1 mg/kg; Infusion: 0.3-0.4 mg/kg/hr
Administration
- IV infusion only; do not administer as IV push or bolus
- Administered by experienced clinicians only
- Use neuromuscular monitoring to evaluate block and recovery
Missed dose
If you miss a dose, consult your doctor.
Side effects
Common Side Effects (≥2%):
- Transient hypotension and hypertension
- Pain on injection (16% with propofol in rapid sequence induction)
Other:
- Anaphylactic/anaphylactoid reactions (rare but fatal)
- Prolonged neuromuscular block
- Myopathy (with corticosteroids in ICU)
Precautions & warnings
- Anaphylactic reactions possible; take necessary precautions
- Histamine release may occur (itching, erythema)
- Prolonged block requires ventilatory support
- Caution in severe hepatic/biliary tract disease and renal failure
Contraindications
- Hypersensitivity to rocuronium, bromide ion, or any excipient
Drug interactions
- Halogenated volatile anesthetics: Potentiate neuromuscular block (maintenance dosing)
- Corticosteroids: Long-term ICU use may prolong block or cause myopathy
- Antibiotics (aminoglycosides, lincosamides, polypeptides): Increased effect
- Phenytoin/carbamazepine: Chronic use decreases effect
- Suxamethonium: May potentiate or attenuate effect
Food interactions
It is not known whether alcohol is safe with Rocuronium Bromide; consult your doctor.
Use in pregnancy
Use in Pregnancy: No harmful effects in animal studies; use with caution; 0.6 mg/kg is safe for Caesarean section; consult your doctor.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Unknown if excreted in human milk; insignificant levels in animal milk; use only if benefits outweigh risks; consult your doctor.
Pediatric use
Insufficient data for neonates (0-1 month); not recommended for pediatric rapid sequence intubation.
Geriatric use
Elderly patients: Standard intubation dose 0.6 mg/kg; consider if prolonged duration is expected.
Renal / hepatic impairment
Renal Impairment: In renal failure: Standard intubation 0.6 mg/kg; maintenance 0.075-0.1 mg/kg; infusion 0.3-0.4 mg/kg/hr; consult your doctor.
Hepatic Impairment: In hepatic/biliary tract disease: Standard intubation 0.6 mg/kg; maintenance 0.075-0.1 mg/kg; infusion 0.3-0.4 mg/kg/hr; consult your doctor.
Overdose effects
Overdose and prolonged block: Continue ventilatory support and sedation; reverse with sugammadex (intense/deep block) or acetylcholinesterase inhibitors (neostigmine) at reappearance of T2.
Storage conditions
Store in a refrigerator at 2-8°C; do not freeze; keep out of reach of children.
Chemical structure
Rocuronium Bromide