Rocuronium

Dosage Forms & Strengths

injectable solution

• 10mg/mL (5 & 10mL vials)

Rapid Sequence Intubation

0.6-1.2 mg/kg IV 

Tracheal Intubation

0.45-0.6 mg/kg IV 

Maintenance: 0.1-0.2 mg/kg IV repeat PRN OR

Continuous infusion: 0.01-0.012 mg/kg/min IV 

Administration

Dose should be calculated based on ideal body weight

Dosage Forms & Strengths

injectable solution

• 10mg/mL (5 & 10mL vials)

Tracheal Intubation

< 3 months

• Safety and efficacy not established

3 months to 14 years

• Initial: 0.6 mg/kg IV
• Maintenance: 0.075-0.125 mg/kg IV OR
• Continuous infusion: 0.012 mcg/kg/min (IV)

> 14 years

• 0.45-0.6 mg/kg IV
• Maintenance: 0.1-0.2 mg/kg IV repeat PRN OR
• Continuous infusion: 0.01-0.012 mg/kg/min IV

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

You will remain under constant supervision during treatment with rocuronium. Your caregivers will watch for any serious side effects. Tell your caregivers right away if you have:

• ongoing muscle weakness; or
• loss of movement in any part of your body (especially in adults who are 65 and older).

Common side effects may include:

• a light-headed feeling, like you might pass out; or
• high blood pressure (severe headache, blurred vision, pounding in your neck or ears, anxiety, confusion).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Rocuronium is injected into a vein through an IV. A healthcare provider will give you this injection.

Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when rocuronium is injected.

Your breathing, blood pressure, oxygen levels, heart function, and other vital signs will be watched closely while you are receiving rocuronium.

It may take you longer to recover from the effects of rocuronium if you have cirrhosis or other liver disease.

Since this medicine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

Since rocuronium is usually given just for anesthesia, you are not likely to be on a dosing schedule.

You should not receive rocuronium if you are allergic to it. Tell your doctor if you have ever had a severe allergic reaction to any type of anesthesia.

To make sure rocuronium is safe for you, tell your doctor if you have:

• myasthenia gravis;

• cirrhosis or other liver disease;

• a history of kidney disease;

• heart disease, circulation problems; or

• a nerve-muscle disorder such as ALS (Lou Gehrig's disease), MS (multiple sclerosis), or muscular dystrophy.

It is not known whether rocuronium will harm an unborn baby. Tell your doctor if you are pregnant.

It is not known whether rocuronium passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

• It is used to calm muscles during surgery.
• It is used to calm muscles while on a breathing machine.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization

Distribution

Vd:

Children: 0.21-0.3 L/kg

Adults: 0.22-0.26 L/kg

Hepatic dysfunction: 0.53 L/kg

Renal dysfunction: 0.34 L/kg

Metabolism

Minimally hepatic; 17-desacetylrocuronium (5% to 10% activity of parent drug)

Excretion

Feces (31%); urine (26%) (Proost 2000)

Clearance: Pediatric patients:

Infants 3 to <12 months: 0.35 L/kg/hour

Children 1 to <3 years: 0.32 L/kg/hour

Children 3 to <8 years: 0.44 L/kg/hour

Patients with clinically significant hepatic impairment had moderately prolonged clinical duration; patients with cirrhosis had increased Vd, prolonged plasma half-life, and >2.5 times the recovery time compared to patients with normal hepatic function.

May be diluted in D5NS, D5W, LR or NS at concentrations up to 5 mg/mL; use within 24 hours of preparation.

AbobotulinumtoxinA: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Acetylcholinesterase Inhibitors: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Amifampridine: May diminish the therapeutic effect of Neuromuscular-Blocking Agents. Neuromuscular-Blocking Agents may diminish the therapeutic effect of Amifampridine. Monitor therapy

Aminoglycosides: May enhance the respiratory depressant effect of Neuromuscular-Blocking Agents. Monitor therapy

Bacitracin (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Calcium Channel Blockers: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

CarBAMazepine: May decrease the serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Cardiac Glycosides: Neuromuscular-Blocking Agents may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy

Clindamycin (Topical): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Colistimethate: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Consider therapy modification

Corticosteroids (Systemic): Neuromuscular-Blocking Agents (Nondepolarizing) may enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Consider therapy modification

CycloSPORINE (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

EPHEDrine (Systemic): May enhance the therapeutic effect of Rocuronium. Monitor therapy

Fosphenytoin-Phenytoin: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Fosphenytoin-Phenytoin may decrease the serum concentration of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Inhalational Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Ketorolac (Nasal): May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Monitor therapy

Ketorolac (Systemic): May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents (Nondepolarizing). Specifically, episodes of apnea have been reported in patients using this combination. Monitor therapy

Lincosamide Antibiotics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Lithium: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Local Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Exceptions: Benzocaine; Benzydamine; Cocaine; Dibucaine; Dyclonine; Ethyl Chloride; Hexylresorcinol; Lidocaine (Ophthalmic); Lidocaine (Topical); Pramoxine; Proparacaine; Tetracaine (Ophthalmic); Tetracaine (Topical). Monitor therapy

Loop Diuretics: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Magnesium Salts: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Minocycline: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

OnabotulinumtoxinA: Neuromuscular-Blocking Agents may enhance the neuromuscular-blocking effect of OnabotulinumtoxinA. Monitor therapy

Pholcodine: May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents. Specifically, anaphylaxis has been reported. Monitor therapy

Polymyxin B: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Consider therapy modification

Procainamide: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

QuiNIDine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

QuiNINE: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Avoid combination

RimabotulinumtoxinB: Neuromuscular-Blocking Agents may enhance the neuromuscular-blocking effect of RimabotulinumtoxinB. Monitor therapy

Spironolactone: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Tetracycline Derivatives: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Trimebutine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Vancomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

Peripheral nerve stimulator measuring twitch response, heart rate, blood pressure, assisted ventilation status