Sugammadex

BRIDION

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Pronunciation: soo-GAM-ma-dex

Sugammadex ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Sugammadex ballicule

Sugammadex BRIDION mascot mnemonic cartoon — Visual mnemonic: Sugammadex mascot
**“Mad sugar”**
molecular cage” encapsulates the rocuronium molecule within a lipophilic core

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.

Sugammadex molecular structure (skeletal formula) — Molecular structure: Sugammadex

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target
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.

Available strengths

inj 100 mg/mL

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

Cost

Sugammadex (BRIDION)

Strength		#/mo	generic $/unit	CostPlus
100 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Sugammadex is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskIt binds hormonal contraceptives for a week

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryN/A (post-2015 labeling)

Defining liabilityAnaphylaxis and abrupt bradycardia or cardiac arrest

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