Rocuronium

Indications
 Intravenous
Muscle relaxant in general anaesthesia, Endotracheal intubation, Aid controlled ventilation
Adult: Initially, 600 mcg/kg by inj. Higher doses of 1 mg/kg may be used for intubation during rapid sequence induction of anaesthesia. Maintenance: 150 mcg/kg by inj (may reduce to 75-100 mcg/kg if inhalational anaesthesia is used) or by infusion at a rate of 300-600 mcg/kg/hr. Doses should be based on lean body weight for obese patients weighing >30% above the ideal body weight.
Child: Infants and children >1 mth: Initially, 600 mcg/kg by inj. Maintenance: 150 mcg/kg by inj or by infusion at a rate of 300-600 mcg/kg/hr, maintenance doses may be required more frequently than in adult patients.
Elderly: Reduced maintenance doses: 75-100 mcg/kg.
Renal impairment: Initially, 600 mcg/kg by inj. Maintenance: 75-100 mcg/kg.
Hepatic impairment: or biliary tract disease: Initially, 600 mcg/kg by inj. Maintenance: 75-100 mcg/kg.

Special Populations: Dose may be reduced in hepatic/renal impaired patients and elderly. Reduce dose in obese patients weighing more than 30% over their ideal body weight, taking into account their lean body mass.
Contraindications
 Hypersensitivity.
Warnings / Precautions
 Pulmonary disease, hepatic, renal impairment, biliary disease, electrolyte/acid-base abnormalities, neuromuscular diseases, DM, dehydrated or severely-ill patients, patients with >40% burns. Ventilation must be supported during neuromuscular blockade. Pregnancy and lactation. Doses >900 mcg/kg may have vagolytic activity.
Adverse Reactions
 Itching and erythematous reactions at the inj site and/or generalised histaminoid reactions. CV changes. Tachycardia and increase in BP.
Potentially Fatal: Abnormal ECG, arrhythmia, bronchospasm, anaphylaxis and malignant hyperthermia.
Overdose Reactions
 May lead to prolonged apnoea due to paralysis of the diaphragm and the intercostal muscles.
Drug Interactions
 May cause enhanced block when used with lidocaine, procainamide, quinidine, verapamil, aminoglycosides, inhalational anaesthetics and vancomycin. May cause prolonged paralysis when used with clindamycin. Anticholinesterases such as pyridostigmine and galantamine may antagonise the effect of rocuronium. Chronic use of carbamazepine or phenytoin may lead to resistance to rocuronium.
See Below for More rocuronium bromide Drug Interactions
Mechanism of Actions
 Rocuronium is a competitive neuromuscular blocker that acts by blocking the binding of acetylcholine to receptors on the motor endplate, inhibiting depolarisation.
Onset: 1-2 min. Max: 4 min.
Duration: 30 min.
Distribution: 30% bound to plasma proteins.
Excretion: Elimination half-life: about 1.2-1.4 hr. Up to 40% of a dose is excreted in the urine within 24 hr. Also excreted in the bile.
Storage Conditions
 Intravenous: Store at 2-8°C.
ATC Classification
 M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
Storage
 Intravenous: Store at 2-8°C.
Available As
  • Rocuronium 10 mg
  • Rocuronium 50 mg

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