Rocuronium

Rocuronium is a prescription medication used as a neuromuscular blocking agent given before general anesthesia in preparation for surgery. 

• Rocuronium is available under the following different brand names: Zemuron

Adult and pediatric dosage

Injectable solution

• 10mg/mL (5 & 10 mL vials)

Rapid Sequence Intubation

• 06.1-2 mg/kg IV

Tracheal Intubation

Adult dosage

• 0.45-0.6 mg/kg IV
• Maintenance: 0.1-0.2 mg/kg IV repeat as needed or
• Continuous infusion: 0.01-0.012 mg/kg/min IV

Pediatric dosage

• Children younger than 3 months of age: Safety and efficacy not established
• Children 3 months to 14 years of age: 
  • Initial: 0.6 mg/kg IV
  • Maintenance: 0.075-0.125 mg/kg IV or
  • Continuous infusion: 0.012 mcg/kg/min (IV)

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Rocuronium include:

• lightheadedness, 
• severe headache, 
• blurred vision, 
• pounding in the neck or ears, 
• anxiety, and 
• confusion

Serious side effects of Rocuronium include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• ongoing muscle weakness, and
• loss of movement in any part of the body (especially in adults who are 65 and older)

Rare side effects of Rocuronium include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Rocuronium has severe interactions with no other drugs.
• Rocuronium has serious interactions with at least 29 other drugs.
• Rocuronium has moderate interactions with at least 111 other drugs.
• Rocuronium has minor interactions with at least 37 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity 
• Lack of ventilatory support, neuromuscular disease
• Other neuromuscular blocking agents

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Rocuronium?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Rocuronium?”

Cautions

• Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent
• Administer only by trained individuals familiar with its actions, characteristics, and hazard
• Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken; neuromuscular cross-sensitivity with other neuromuscular blocking agents possible
• Neuromuscular transmission should be monitored continuously during administration and recovery with the help of a nerve stimulator; additional doses of rocuronium or any other neuromuscular blocking agent should not be given until there is a definite response (one twitch of the train-of-four) to nerve stimulation
• Use caution in patients with significant hepatic disease; if used for rapid sequence induction in patients with ascites, an increased initial dosage may be necessary to assure complete block
• Some patients may experience prolonged recovery (paralysis) of neuromuscular function
• Adequate ventilatory support mandatory, may experience resistance with over 25% TBSA burns, may experience increased sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)
• When used with other agents, occurrence of malignant hyperthermia during anesthesia is possible even in the absence of known triggering agents; clinicians should be familiar with early signs, confirmatory diagnosis and treatment of malignant hyperthermia prior to initiating any anesthetic
• Conditions associated with slower circulation time, eg, cardiovascular disease or advanced age, may be associated with a delay in onset time; since higher doses of rocuronium bromide injection produce longer duration of action, initial dosage should not be increased in these patients to reduce onset time; instead, when feasible, more time should be allowed for the drug to achieve onset of effect; geriatric patients (65 years or older) may be at increased risk for residual neuromuscular block
• Administration results in paralysis, which may lead to respiratory arrest and death, a progression that may be more likely to occur in a patient for whom drug is not intended; confirm proper selection of intended product and avoid confusion with other injectable solutions that are present in critical care and other clinical settings; if another healthcare provider is administering product, ensure that the intended dose is clearly labeled and communicated

Pregnancy and Lactation

• Use with caution if benefits outweigh risks in pregnancy. 
• Not known if excreted in breast milk; effect on nursing infants not known