Sugammadex: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
'''IV bolus injection infused over 10 seconds via central or peripheral line with 16 mg/kg will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.'''<ref>Abrishami A et al. "Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade". Cochrane Database of Systematic Reviews. 2009(4). CD007362. doi:10.1002/14651858.CD007362.pub2. PMID 19821409</ref> | '''IV bolus injection infused over 10 seconds via central or peripheral line with 16 mg/kg will reverse a single 1.2 mg/kg dose of [[rocuronium]] in approximately 3 minutes.'''<ref>Abrishami A et al. "Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade". Cochrane Database of Systematic Reviews. 2009(4). CD007362. doi:10.1002/14651858.CD007362.pub2. PMID 19821409</ref> | ||
*4 mg/kg if patient has no twitch responses to train-of-four and emergent reverse is not needed | *4 mg/kg if patient has no twitch responses to train-of-four and emergent reverse is not needed | ||
*2mg/kg if patient has a second twitch after train of four and no emergent reversal is needed | *2mg/kg if patient has a second twitch after train of four and no emergent reversal is needed | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*No approved dosing or usage | *No approved dosing or usage | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: There are no data on use in pregnant women | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: There are no data on use in pregnant women | ||
*[[Lactation risk categories|Lactation risk]]: Unknown | *[[Lactation risk categories|Lactation risk]]: Unknown | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: Unknown | *Adult: Unknown | ||
*Pediatric: Unknown | *Pediatric: Unknown | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
*Adult: Unknown | *Adult: Unknown | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
Adverse effects are described in the anesthesia literature and the most serious side effect is in patients with a known hypersensitivity to Sugammadex<ref>Park J. Benefits and risks of sugammadex. Korean J Anesthesiol. 2015 Feb; 68(1): 1–2.</ref> | Adverse effects are described in the anesthesia literature and the most serious side effect is in patients with a known hypersensitivity to Sugammadex<ref>Park J. Benefits and risks of sugammadex. Korean J Anesthesiol. 2015 Feb; 68(1): 1–2.</ref> | ||
===Serious=== | ===Serious=== | ||
*Anaphylaxis (0.3%), hypersensitivity reaction | *[[Anaphylaxis]] (0.3%), hypersensitivity reaction | ||
*Bradycardia (1-5%) | *Bradycardia (1-5%) | ||
*Prolonged QT | *[[Prolonged QT]] | ||
===Common=== | ===Common=== | ||
*Nausea/vomiting | *[[Nausea/vomiting]] | ||
*Headache | *[[Headache]] | ||
*Coughing | *Coughing | ||
*Extremity pain | *Extremity pain | ||
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*Metabolism: | *Metabolism: | ||
*Excretion: Renal | *Excretion: Renal | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
*Encapsulates rocuronium or vecuronium in plasma, reducing the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction and thereby reversing neuromuscular blockade | *Encapsulates [[rocuronium]] or [[vecuronium]] in plasma, reducing the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction and thereby reversing neuromuscular blockade | ||
==Comments== | ==Comments== | ||
Revision as of 03:18, 5 January 2017
Administration
- Type/Class: γ-cyclodextrin, antidote
- Dosage Forms:
- 200mg/2mL (100mg/mL)
- 500mg/5mL (100mg/mL)
- Routes of Administration: IV
- Common Trade Names: Bridion
Adult Dosing
IV bolus injection infused over 10 seconds via central or peripheral line with 16 mg/kg will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.[1]
- 4 mg/kg if patient has no twitch responses to train-of-four and emergent reverse is not needed
- 2mg/kg if patient has a second twitch after train of four and no emergent reversal is needed
Pediatric Dosing
- No approved dosing or usage
Special Populations
- Pregnancy Rating: There are no data on use in pregnant women
- Lactation risk: Unknown
Renal Dosing
- Adult: Unknown
- Pediatric: Unknown
Hepatic Dosing
- Adult: Unknown
- Pediatric: Unknown
Contraindications
- Allergy to class/drug and or prior documentation of hypersensitivity
Adverse Reactions
Adverse effects are described in the anesthesia literature and the most serious side effect is in patients with a known hypersensitivity to Sugammadex[2]
Serious
- Anaphylaxis (0.3%), hypersensitivity reaction
- Bradycardia (1-5%)
- Prolonged QT
Common
- Nausea/vomiting
- Headache
- Coughing
- Extremity pain
- Parosmia, hypoesthesia
Pharmacology
- Onset of action: reverses paralysis in ~3 minutes
- Half-life: 2h
- Metabolism:
- Excretion: Renal
Mechanism of Action
- Encapsulates rocuronium or vecuronium in plasma, reducing the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction and thereby reversing neuromuscular blockade
Comments
- Sugammadex is only FDA approved for reversal for patients undergoing surgery. The drug has been used in Europe since 2008[3]
See Also
References
- ↑ Abrishami A et al. "Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade". Cochrane Database of Systematic Reviews. 2009(4). CD007362. doi:10.1002/14651858.CD007362.pub2. PMID 19821409
- ↑ Park J. Benefits and risks of sugammadex. Korean J Anesthesiol. 2015 Feb; 68(1): 1–2.
- ↑ Assessment Report for Bridion. European Medicines Agency