Trade Names:Zemuron- Injection 10 mg/mL
Binds competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.
Rapid distribution half-life is 1 to 2 min and the slower distribution half-life is 14 to 18 min. Plasma protein binding is approximately 30%.
Because of the limited role of the kidney in rocuronium elimination, follow usual dosing guidelines.Hepatic Function Impairment
Because rocuronium is primarily excreted by the liver, use with caution in patients with clinically significant hepatic impairment.Elderly
Observed pharmacokinetic effects for patients 65 yr of age and older were similar to other adult patients. Onset time and duration of action are slightly longer in elderly patients.
As an adjunct to general anesthesia for inpatients and outpatients to facilitate both rapid sequence and routine tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Use of a peripheral nerve stimulator is recommended to monitor drug response and determine the need for additional relaxant and adequacy of spontaneous recovery or antagonism.Continuous InfusionAdults
IV 0.01 to 0.012 mg/kg per min initiated only after early evidence of spontaneous recovery from the intubating dose.Individualization of DosageChildren
IV 0.45 to 0.6 mg/kg, depending on anesthetic technique and age of the patient. The infusion must be individualized for each patient. Adjust the rate of administration according to the patients twitch response as monitored with the use of a peripheral nerve stimulator.Maintenance
When used for general anesthesia, patients ranging from 3 mo of age through adolescence administered rocuronium maintenance dose of 0.075 to 0.125 mg/kg administered upon return of T 1 to 0.25%, halothane can provide clinical relaxation for 7 to 10 min. Alternatively, a continuous infusion of rocuronium initiated at a rate of 12 mcg/kg/min upon return of T 1 to 10% (1 twitch present in train-of-four), may also be used to maintain neuromuscular blockade in children. With sevoflurane induction, doses of rocuronium 0.45 mg/kg and 0.6 mg/kg, in general, produce excellent to good intubating conditions within 75 sec. When halothane is used, a 0.6 mg/kg dose of rocuronium resulted in excellent to good intubating conditions within 60 sec. When sevoflurane is used for induction and isoflurane/nitrous oxide for maintenance of general anesthesia, maintenance dosing of rocuronium 0.15 mg/kg can be administered as bolus doses at reappearance of T 3 in all pediatric age groups. Maintenance dosing at a rate of 7 to 10 mcg/kg/min can be administered at the reappearance of T 2 with the lowest dose requirement for neonates (ie, birth to younger than 28 days of age) and the highest dose requirement for children (ie, older than 2 yr of age up to 11 yr of age).Elderly (65 yr of age and older)
IV Exhibited slightly prolonged median clinical duration under opioid/nitrous oxide/oxygen anesthesia following doses of 0.6, 0.9, and 1.2 mg/kg, respectively.Maintenance dose
0.1 to 0.15 mg/kg administered at 25% recovery of T 1 .MaintenanceAdults
IV 0.1, 0.15, and 0.2 mg/kg administered at 25% recovery of control T 1 (defined as 3 twitches of train-of-four).Rapid Sequence IntubationAdults
IV 0.6 to 1.2 mg/kg provides excellent to good intubating conditions in most patients in less than 2 min.Tracheal IntubationAdults
IV 0.6 mg/kg as a recommended initial dose. Good intubation conditions usually occur within 2 min.
Store vials in refrigerator (36° to 46°F). Do not freeze. May be removed from refrigerator and stored at controlled room temperature (less than 77°F), but injection must be used within 60 days. Once vial has been opened, use within 30 days. Use within 24 h of mixing.
May enhance the neuromuscular blocking action of rocuronium.Carbamazepine, phenytoin
Resistance to neuromuscular blocking action of rocuronium may occur.General anesthetic agents
QT interval may be prolonged.Nitrous oxide/oxygen with either enflurane or isoflurane
May prolong the clinically effective duration of action of initial and maintenance doses of rocuronium and decrease the required infusion rate.Succinylcholine
Time of onset of max block following rocuronium may be faster with prior administration of succinylcholine.
Should not be mixed with alkaline solutions (eg, barbiturates) in the same syringe or administered simultaneously during IV infusion through the same needle.
None well documented.
Increased pulmonary vascular resistance (24%); abnormal ECG, arrhythmia, hypertension, hypotension, tachycardia (less than 1%).
Pruritus, rash (less than 1%).
Nausea, vomiting (less than 1%).
Severe allergic reactions, including life-threatening and fatal anaphylactoid and anaphylactic reactions and shock (postmarketing).
Injection-site edema (less than 1%).
Myopathy; residual paralysis.
Asthma (bronchospasm, rhonchi, wheezing), hiccup (less than 1%).
Category C .
Sevoflurane induction has been studied in neonates and children up to 17 yr of age. Rocuronium is not recommended for rapid sequence intubation in children. Use in children younger than 3 mo of age or older than 14 yr of age under halothane anesthesia has not been studied.
Rare, severe, or life-threatening anaphylactic reactions have been reported.
Use with caution.
May have profound effect in patients with neuromuscular disease (eg, myasthenia gravis). Patients with burns, hemiparesis, or paraparesis may have resistance to rocuronium. Severe acid-base and/or electrolyte abnormalities may potentiate or cause resistance.
Under the supervision of experienced clinicians who are familiar with rocuronium action and complications. Personnel and facilities for resuscitation and life support and an antagonist of rocuronium should be immediately available.
May be delayed in patients with slower circulation time (eg, CV disease).
Because rocuronium may be associated with increased pulmonary vascular resistance, use with caution in patients with pulmonary hypertension or valvular heart disease.
In order to prevent complications resulting from residual paralysis, it is recommended to extubate only after patient recovers sufficiently from neuromuscular block.
Tolerance may develop during chronic administration in the intensive care unit.
Prolonged neuromuscular block.
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