ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Esmeron
ICU INDICATIONS:
- Muscle relaxant
PRESENTATION AND ADMINISTRATION:
IV:
50 mg in 5 mL solution
Supplied as a clear, aqueous solution for intravenous injection.
Administer neat for IV injection or infusion.
Compatible with the following IV fluids: 5% dextrose, Normal saline, Hartmanns, Glucose and sodium chloride
Store in the refrigerator at 2 - 8°C. The product can be stored outside the refrigerator at a temperature of up to 30°C for a maximum of 12 weeks. The product may not be placed back, once kept outside the refrigerator.
DOSAGE:
IV:
Induction:
0.6 - 1.2 mg/kg stat
Ongoing:
0.1 - 0.2 mg/kg boluses or 5 - 15 mcg/kg/min infusion
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function. Duration of action may be prolonged.
DOSAGE IN PAEDIATRICS:
IV:
Induction:
0.6 - 1.2 mg/kg stat
Ongoing:
0.1 - 0.2 mg/kg boluses or 5 - 15 mcg/kg/min infusion
CLINICAL PHARMACOLOGY:
Rocuronium is a fast onset, intermediate acting non-depolarising neuromuscular blocking agent. It competes for nicotinic cholinoceptors at the motor end-plate. This action is antagonized by acetylcholinesterase inhibitors such as neostigmine, edrophonium and pyridostigmine. The actions of rocuronium can be specifically reversed with the administration of sugammadex.
During rapid sequence induction of anaesthesia with propofol, adequate inubating conditions can be achieved in nearly all patients 60 seconds after administration of a dose of 1 mg/kg of rocuronium. This dose provides adequate paralysis for up to 1 hour.
The recovery of train-of-four twitch assessment from rocuronium given by continuous infusion in ICU for 20 hours may take up to 1.5 hours in patients without multiorgan failure, and 4 hours in patients with multiorgan failure.
CONTRAINDICATIONS:
- Hypersensitivity to rocuronium
Anaphylactic reactions can occur following the administration of neuromuscular blocking agents including rocuronium.
PRECAUTIONS:
General:
In general, following long term use of neuromuscular blocking agents in the ICU, prolonged paralysis and/or skeletal muscle weakness has been noted. Myopathy after long term administration of other non-depolarising neuromuscular blocking agents in the ICU in combination with corticosteroid therapy has been reported regularly. Therefore, for patients receiving both neuromuscular blocking agents and corticosteroids, the period of use of the neuromuscular blocking agent should be limited as much as possible.
Like other neuromuscular blocking agents, rocuronium should be used with extreme caution in patients with a neuromuscular disease.
Laboratory Tests:
No tests additional to routine ICU tests are required
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Drugs which may enhance the neuromuscular blocking action of rocuronium include:
- Antibiotics including aminoglycosides and polymyxins
- Lithium
- Magnesium salt
- Procainamide
- Quinidine.
The prior administration of succinylcholine does not enhance the duration, but quickens the onset and may increase the depth, of neuromuscular block induced by rocuronium.
ADVERSE REACTIONS:
General:
Allergic reactions (anaphylactic or anaphylactoid responses) which, in rare instances, were severe (such as cardiac arrest)
Musculoskeletal:
Inadequate block, prolonged block
Cardiovascular:
Hypotension, vasodilatation (flushing), tachycardia, bradycardia
Respiratory:
Dyspnoea, bronchospasm, laryngospasm
Integumentary:
Rash, urticaria, reaction at injection site