Rocuronium
ZEMURON
“Zemur on Rocker”
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
Read the full label on DailyMed ↗
| 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
Available strengths
- inj 10 mg/mL
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
Adverse reactions
- Transient hypotension
- Transient hypertension
- Arrhythmia/tachycardia
- Nausea/vomiting
- Bronchospasm/wheezing
- Rash, injection-site edema, pruritus
Pregnancy No drug-associated risk identified over decades of use; not recommended for rapid sequence induction in Cesarean section.
Lactation No available data.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 10 mg/mL | inj | per unit | $0.39/mL | not offered |
NO BOXED WARNINGS
Principal riskNo sedation whatever — awareness under paralysis
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory paralysis requiring mechanical ventilation
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