Rocuronium

ZEMURON

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What it isNon-depolarizing nicotinic antagonist; neuromuscular blockade for intubation and surgery.

Why this oneIt gives intubating conditions in about a minute at high dose without succinylcholine’s hazards, and sugammadex reverses it immediately.

What limits itNo sedative or analgesic effect whatever — awareness under paralysis is the danger. Duration is prolonged in hepatic impairment.

FDA-approved for

neuromuscular blockade (surgery) (1994)

FDA label

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FDA dosing	Population	Start	Target	Max
Tracheal intubation (neuromuscular blockade)	Adults	0.6 mg/kg IV (0.45 mg/kg lower option; up to 0.9-1.2 mg/kg bolus)	0.6 mg/kg IV	1.2 mg/kg IV
Rapid sequence intubation	Adults	0.6-1.2 mg/kg IV	0.6-1.2 mg/kg IV	1.2 mg/kg IV
Maintenance of neuromuscular block	Adults	0.1-0.2 mg/kg IV at 25% T1 recovery	0.1-0.2 mg/kg IV PRN
Continuous infusion maintenance	Adults	10-12 mcg/kg/min IV	4-16 mcg/kg/min IV (titrate to twitch)
Tracheal intubation	Pediatric	0.6 mg/kg IV (0.45 mg/kg option)	0.6 mg/kg IV

Renal No dosage adjustment (limited renal excretion); duration not prolonged but variable

Hepatic Use with caution; clinical duration prolonged in significant hepatic impairment; higher initial dose may be needed for RSI in ascites

Reduce infusion rate 30-50% with enflurane/isoflurane; potentiated in neuromuscular disease and hypermagnesemia; resistance with burns and chronic anticonvulsants

Instructions

IV use only; individualize dose and monitor with a peripheral nerve stimulator
Use only where intubation, mechanical ventilation, oxygen therapy, and an antagonist are immediately available
Must be accompanied by adequate anesthesia or sedation (no effect on consciousness or pain)
Do not mix with alkaline solutions (e.g., barbiturates)
For infusion, dilute to 0.5-5 mg/mL in D5W or lactated Ringer's; use within 24 h
Consider a reversal agent to prevent residual paralysis, especially in geriatric patients

Contraindications

Known hypersensitivity (e.g., anaphylaxis) to rocuronium or other neuromuscular blocking agents (cross-reactivity)

Cautions

Severe anaphylaxis; cross-reactivity among neuromuscular blocking agents
Risk of death from medication errors (accidental administration)
Requires adequate anesthesia/sedation
Residual paralysis - extubate only after sufficient recovery; higher risk in geriatric patients
Long-term ICU use: tolerance and myopathy (especially with corticosteroids)
Malignant hyperthermia reported
QTc prolongation with concomitant general anesthetics (pediatric data)
Increased pulmonary vascular resistance - caution in pulmonary hypertension/valvular disease
Profound effects in myasthenia gravis or Eaton-Lambert syndrome