SUGAMMADEX 100mg/ml, 2ml, vial

• Not in the WHO list of Essential Medicines 2025

Selective relaxant-binding agent

Antagonist to non-depolarizing neuromuscular blocking agents

Reversal of neuromuscular blockade induced by rocuronium or vecuronium only.

Sugammadex is superior to neostigmine and considered the first-line treatment in the following situations:

• As rescue therapy in rare but life-threatening “cannot intubate, cannot ventilate” situation when rocuronium was used
• For operations terminated prematurely, soon after a profound depth of neuromuscular blockade has been induced
• In intubated or extubated patients who are not adequately reversed with neostigmine
• In patients with contraindications to other reversal agents

Treatment with neostigmine presents limitations that may prevent the rapid reversal of neuromuscular blockade when needed.

Must be given into the IV infusion line as a single rapid bolus over 10 seconds. The IV line should be flushed prior to and post administration (Flush-Dose-Flush).

In paediatric patients, dilute in 0.9% NaCl to a concentration of 10 mg/mL.

Must only be administered by/under supervision of an anaesthetist.

Posology:

• Monitor for twitch responses to determine the timing and dose for sugammadex administration:
• 2 mg/kg if spontaneous recovery has occurred up to at least the reappearance of T2 on TOF
• 4 mg/kg TOF = 0 but recovery has reached at least 1 - 2 post tetanic counts.
• 16 mg/kg for immediate reversal of rocuronium (less reliable for vecuronium)
• If required, wait 4 hours before re-administering rocuronium or vecuronium after up to 4 mg/kg sugammadex. After 16 mg/kg or with severe renal impairment, wait 24 hours.

Reversal of non-depolarizing muscle relaxants (vecuronium, rocuronium) with sugammadex should be monitored using a peripheral nerve stimulator.

Systematically order the corresponding pre-printed label to identify the syringe containing the product.

Sugammadex should be ordered together with rocuronium.