Sugammadex
BRIDION
What it isModified gamma-cyclodextrin that encapsulates rocuronium and vecuronium; reversal of neuromuscular blockade.
Why this oneIt reverses even profound blockade within minutes, which neostigmine cannot, and needs no antimuscarinic cover.
What limits itIt binds hormonal contraceptives, so a week of alternative contraception is required. Bradycardia; it does not reverse succinylcholine.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Reversal of rocuronium/vecuronium block — deep (1-2 PTC, no TOF twitches) | Adults, single IV bolus | 4 mg/kg | 4 mg/kg | |
| Reversal of rocuronium/vecuronium block — moderate (2nd TOF twitch reappeared) | Adults, single IV bolus | 2 mg/kg | 2 mg/kg | |
| Immediate reversal (~3 min after 1.2 mg/kg rocuronium; rocuronium only) | Adults, single IV bolus | 16 mg/kg | 16 mg/kg |
Renal Not recommended in severe renal impairment (CrCl <30 mL/min), including patients on dialysis.
Hepatic Undefined
Waiting time to re-administer an NMBA depends on sugammadex dose and renal function; consider a nonsteroidal NMBA.
Instructions
- Dose based on actual body weight and TOF/PTC monitoring.
- Administer as a single IV bolus over 10 seconds into an existing IV line.
- May dilute 100 mg/mL to 10 mg/mL with 0.9% NaCl for pediatric dosing accuracy.
Cautions
- Anaphylaxis and hypersensitivity (may occur with no prior exposure)
- Marked bradycardia, occasionally cardiac arrest — treat with atropine
- Ventilatory support mandatory until adequate spontaneous respiration restored
- Recurrence of neuromuscular blockade
Adverse reactions
- Vomiting
- Pain
- Nausea
- Hypotension
- Headache
Pregnancy Insufficient human data; animal studies showed reduced fetal weight/ossification at high (maternally toxic) doses.
Lactation Undefined
NO BOXED WARNINGS
Principal riskIt binds hormonal contraceptives for a week
Classes and tags
Clinical profile
Mechanism of action: Sugammadex ballicule
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Memory aids: mascots and interaction avatars
molecular cage” encapsulates the rocuronium molecule within a lipophilic core