Sugammadex
Click on Graphic to download file - European document that outlines the drug in detail. (238 KB)
Developed and approved by The Committee on Quality, Efficiency and Patient Satisfaction (QEP).
Sugammadex is available in 2 and 5 mL vials in a concentration of 100 mg/mL. Sugammadex reverses neuromuscular blockade induced by rocuronium or vecuronium.
Guidelines for use could include:
- As rescue therapy in a rare but life threatening “cannot intubate, cannot ventilate when rocuronium or vecuronium was used.
- Failure to intubate after rocuronium or vecuronium when ventilation without airway protection is contra-indicated e.g. the full stomach.
- When a deep neuromuscular block is present that cannot be reversed with neostigmine (<1-2 twitches in TOF).
- For patients who are inadequately reversed with neostigmine.
- Suspected anaphylaxis to rocuronium.
- Neostigmine/glycopyrolate is contra-indicated, e.g. proven rate related myocardial ischemia, unstable atrial fibrillation, and severe asthma.
- For use during pregnancy and postpartum
Recommended Dosages
| Indication | Dose |
| Cannot intubate, cannot ventilate | 16 mg/kg |
| Deep reversal (zero twitches, if recovery has reached at least post tetanic count of 1-2) | 4 mg/kg |
| Standard reversal (1-2 twitches in TOF) | 2 mg/kg |
After inadequate neostigmine reversal sugammadex dose depends on TOF (same as indicated in the above table).
Neuromuscular blockade monitoring and documentation of the results in EPIC will be required before sugammadex administration.
Precautions:
Women taking oral contraceptives: Sugammadex may decrease progesterone levels and patients using hormonal contraceptives must use an additional, non-hormonal method of contraception for the next 7 days. Sugammadex administration in patients taking oral contraceptives will require patient counseling by the attending anesthesiologist regarding the need for non-hormonal contraceptives in the next 7 days.
Renal insufficiency: Sugammadex is not recommended in patients with severe renal impairment (CrCl <30 mL/min).
Effect on hemostasis: APTT and PT will be prolonged by ~ 20% for up to 30-60 min.
Neuromuscular blockade need after sugammadex administration: Use succinylcholine or a non-steroidal (cis-atracurium) neuromuscular blocker. Waiting period for repeat rocuronium or vecuronium after sugammadex is dose and patient (renal function) dependent. See package insert. After a 200 mg sugammadex dose a waiting period > 12 hours is recommended by some.
Floxacillin and toremifene: These drugs may displace rocuronium or vecuronium from Sugammadex resulting in recurrence of neuromuscular blockade.
Physical Incompatibility: Sugammadex is physically incompatible with ondansetron, verapamil, and ranitidine.
Hypotension and bradycardia have been observed immediately after administration
Anaphylaxis: Anaphylaxis has occurred in 0.3% of healthy volunteers.
The current Stanford Pharmacy acquisition costs for the different reversal agents are:
- Sugammadex 200mg/2ml vial = $91.21
- Neostigmine 5mg/10ml vial = $62.67
- Glycopyrrolate 1mg /5ml vial = $29.15
