unexpectedly [2:10% of control). 1 May need to reduce infusion rate by about 30 50% approximately 45 60 minutes following the initial IV dose if steady-state anesthesia has been induced with enflurane or isoflurane. 1 Special Populations Hepatic Impairment Increased initial dose may be required for rapid sequence induction to achieve effective neuromuscular blockade (however, doses >0.6 mg/kg have not been evaluated); once blockade is established, duration may be prolonged. 1 (See Hepatic Impairment under Cautions.) Renal Impairment Dosage adjustments not required; individualize dosage. 1 (See Renal Impairment under Cautions.) Geriatric Patients Manufacturer makes no dosage recommendations. 1 (See Geriatric Use under Cautions.) Burn Patients Substantially increased doses may be required due to development of resistance. a (See Burn Patients under Cautions.) Patients with Impaired Circulation Onset time may be delayed; however, larger than usual doses generally not recommended. 1 When feasible, allow more time for rocuronium to achieve its effect. 1 Obese Patients Base dosage on actual body weight. 1 Patients with Neuromuscular Disease Administer small test dose; monitor degree of neuromuscular blockade with a peripheral nerve stimulator to determine dosage requirements. 1 (See Neuromuscular Diseases under Cautions.) Cautions for Rocuronium Bromide Contraindications Known hypersensitivity to rocuronium bromide or any ingredient in the formulation. 1 Warnings/Precautions Warnings Administration Precautions Because of the potential for severely compromised respiratory function and other complications, take special precautions during administration. 1 (See Boxed Warning and also see General under Dosage and Administration.) Sensitivity Reactions Hypersensitivity Reactions Serious hypersensitivity reactions, including anaphylaxis, reported rarely. 1 422 Potential for cross-sensitivity with other neuromuscular blocking agents (both depolarizing and nondepolarizing). 1 Take appropriate precautions; emergency treatment for anaphylaxis should be immediately available. 1 General Precautions Burn Patients Resistance to therapy with neuromuscular blocking agents can develop in burn patients, 1 particularly those with burns over 25 30% or more of body surface area. a Resistance generally becomes apparent 1 week after the burn, a peaks 2 weeks after the burn, a persists for several months or longer, a and decreases gradually with healing. a Consider possible need for substantially increased doses. a Neuromuscular Diseases Possible profound neuromuscular blockade in patients with neuromuscular diseases (e.g., myasthenia gravis, Eaton-Lambert syndrome). 1 Administer small test dose; monitor degree of neuromuscular blockade with a peripheral nerve stimulator. 1 Conditions that May Potentiate or Cause Resistance to Neuromuscular Blocking Agents Neuromuscular blockade may be potentiated in patients with debilitation, cachexia, or carcinomatosis or in those receiving certain concomitant drugs (e.g., enflurane, isoflurane, antibiotics, magnesium salts, lithium, local anesthetics, procainamide, quinidine). 1 A reduction in rocuronium dosage may be required. 1 Conditions that may cause resistance to nondepolarizing neuromuscular blocking agents include burns, disuse atrophy, denervation, direct muscle trauma, and long-term use of carbamazepine, phenytoin, or neuromuscular blocking agents. 1 An increase in rocuronium dosage may be required. 1 Cardiovascular Effects Possible increased pulmonary vascular resistance; use with caution in patients with pulmonary hypertension or valvular heart disease. 1 Patients with conditions that prolong circulation time (e.g., cardiovascular disease) may experience a delay in onset time of rocuronium. 1 Intensive Care Setting Possible prolonged paralysis and/or muscle weakness or myopathy with long-term use of neuromuscular blocking agents in the ICU. 1 420 Continuous monitoring of neuromuscular transmission recommended during neuromuscular blocking agent therapy in intensive care setting. 1 Do not administer additional doses before there is a definite response to nerve stimulation tests. 1 Residual Paralysis Residual neuromuscular blockade can occur as a result of drug (or metabolite) accumulation or concomitant use of certain drugs. 1 420 421 Consider use of a reversal agent. 1 (See Reversal of Neuromuscular Blockade under Dosage and Administration.) Extubate patients only when adequate recovery of neuromuscular function is assured. 1 Electrolyte Disturbances Possible increased or decreased neuromuscular blockade in patients with electrolyte disturbances (e.g., diarrhea, adrenocortical insufficiency) or acid/base imbalances. 1 a QT Interval Prolongation Prolongation of the QT interval reported in pediatric patients receiving rocuronium and general anesthetics concomitantly. 1 Malignant Hyperthermia Malignant hyperthermia is rarely associated with use of neuromuscular blocking agents and/or potent inhalation anesthetics. 1 a Be vigilant for its possible development and prepared for its management in any patient undergoing general anesthesia. 1 Rocuronium has not been evaluated in patients susceptible to malignant hyperthermia. 1 Local Effects Possible local irritation; discontinue injection and restart in another vein if extravasation occurs. 1 Specific Populations Pregnancy Category C. 1 Possible poor or inadequate intubating conditions following rapid sequence induction in cesarean section patients; use not recommended for rapid sequence induction in such patients. 1 Lactation Not known whether rocuronium is distributed into milk. 1 Pediatric Use Has been evaluated in pediatric patients of all ages, including neonates, under sevoflurane and isoflurane/nitrous oxide anesthesia, and children 3 months to 14 years of age under halothane anesthesia. 1 Manufacturer states that rocuronium is not recommended for rapid sequence intubation in pediatric patients. 1 Geriatric Use Slightly slower onset and slightly increased duration of neuromuscular blockade; however, recovery time in patients 65 years of age does not appear to differ from that in younger adults. 1 Hepatic Impairment Possible incomplete neuromuscular blockade; increased initial dosage may be required. 1 See Hepatic Impairment under Dosage and Administration. Use with caution. 1 Possible increase in half-life, duration of neuromuscular blockade, and recovery time. 1 (See Special Populations under Absorption and also under Elimination, in Pharmacokinetics.) Renal Impairment No substantial differences in pharmacokinetic profile relative to patients without renal impairment. 1 (See Absorption: Special Populations, under Pharmacokinetics.) Common Adverse Effects Transient hypotension and hypertension. 1 Interactions for Rocuronium Bromide Specific Drugs Drug Interaction Comments Anesthetics, general (enflurane, isoflurane) Increased potency and prolonged duration of neuromuscular blockade 1 Reduced rocuronium infusion rate may be required 1 Anesthetics, local Possible increased neuromuscular blockade 1 Reduced initial rocuronium dosage may be required 1 Anticonvulsants (carbamazepine, phenytoin) Possible resistance to rocuronium in patients receiving long-term phenytoin or carbamazepine therapy 1 Higher rocuronium infusion rates may be required 1 Anti-infectives (e.g., aminoglycosides, bacitracin, polymyxins, tetracyclines, vancomycin) Possible prolonged duration of neuromuscular blockade 1 Reduced rocuronium dosage may be required 1 Lithium Possible increased neuromuscular blockade 1 Reduced rocuronium dosage may be required 1 Magnesium salts Increased neuromuscular blockade 1 Reduced rocuronium dosage may be required 1 Neuromuscular blocking agents, nondepolarizing Interactions have not been observed 1 Procainamide Possible increased neuromuscular blockade 1 Reduced rocuronium dosage may be required 1 Propofol Change in duration of, or recovery from, neuromuscular blockade unlikely 1 Quinidine Possible increased neuromuscular blockade; possible recurrence of paralysis 1 Reduced initial rocuronium dosage may be required 1 Succinylcholine Possible increased duration of neuromuscular blockade 1 Administer rocuronium only after patient has recovered form succinylcholine-induced neuromuscular blockade 1 Rocuronium Bromide Pharmacokinetics Absorption Bioavailability Poorly absorbed from the GI tract. a Onset Onset of action is slower than that of succinylcholine but more rapid than that of most other currently available nondepolarizing agents. 2 3 4 5 6 7 8 Onset of neuromuscular blockade is more rapid in pediatric patients than adults. 1 Following IV administration of 0.45 or 0.6 mg/kg in adults, neuromuscular blockade is clinically sufficient in about 1.3 (range 0.8 6.2) or 1 (range: 0.4 6) minute, respectively, and is maximal in]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Manufacturers Mylan Pharmaceuticals Inc. Pfizer Inc. Sandoz Inc. X-GEN Pharmaceuticals, Inc. Fresenius Kabi USA, LLC More... Drug Class Neuromuscular blocking agents Related Drugs Anesthesia lidocaine , fentanyl , hyoscyamine , propofol , Levsin , ketamine , glycopyrrolate , Emla , Robinul , butorphanol , etomidate , succinylcholine , Nubain , Diprivan , benzocaine topical , Stadol , Levbid , rocuronium , Talwin , pentazocine , Sublimaze , sevoflurane , nalbuphine , Anaspaz , HyoMax , More... Rocuronium Rating 3 User Reviews 5.5 /10 3 User Reviews 5.5 Rate it!} } customer service
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