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- Check the BNF or equivalent for up-to-date prescribing advice.
Mode of action
- A modified γ-cyclodextrin, used for the reversal of aminosteroid neuromuscular blockers.
- Inactivates rocuronium and vecuronium by encapsulating (chelating) the free molecule.
- Binds to free aminosteroid in the plasma, creating a concentration gradient between the plasma and the neuromuscular junction. The aminosteroid moves down this concentration gradient, reducing the concentration at the neuromuscular junction.
- Has a very high association rate with a very low dissociation rate. Therefore, once encapsulated, the aminosteroid is not easily released back to its free form.
- Excreted unchanged in the urine.
- For children: 2mg/kg for routine reversal of neuromuscular blockade by rocuronium in 2-17-year-olds.
- For adults: 16mg/kg for immediate reversal of neuromuscular blockade by rocuronium.
- For adults: 4mg/kg for reversal of deep neuromuscular blockade by rocuronium or vecuronium. 2mg/kg for reversal of moderate neuromuscular blockade by rocuronium or vecuronium. Further doses of 4mg/kg should be used if reoccurrence of neuromuscular blockade.
- Interacts with the oral contraceptive pill. After administration of sugammadex the patient should be advised to follow their missed pill protocol for their specific contraceptive.
- Recovery may be delayed in those with cardiovascular disease and the elderly.
- Rocuronium should not be re-administered for 24 hours after a dose of sugammadex. This is an important consideration if the patient needs to return to theatre in the immediate post operative period.
- There is an association between sugammadex administration and increased risk of post-operative bleeding.
- Avoid when creatinine clearance is <30mL/minute.
- Vomiting, dry mouth, tachycardia, and dizziness.
- Hypersensitivity and bronchospasm
- Nag, K., Singh, D. R., Shetti, A. N., Kumar, H., Sivashanmugam, T., & Parthasarathy, S. (2013). Sugammadex: A revolutionary drug in neuromuscular pharmacology. Anesthesia, essays and researches, 7(3), 302–306. https://doi.org/10.4103/0259-1162.123211
- Chang, H. W., Lee, I. O., Kang, H., Won, Y. J., & Lim, Y. S. (2021). Coagulation Effect of Sugammadex as Determined by Thromboelastography in a Randomized Controlled Study of Surgical Patients. International journal of medical sciences, 18(6), 1318–1324. https://doi.org/10.7150/ijms.42563