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rocuronium (Rx)Brand and Other Names:Zemuron

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL (5 & 10mL vials)
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Rapid Sequence Intubation

0.6-1.2 mg/kg IV 

Tracheal Intubation

0.45-0.6 mg/kg IV 

Maintenance: 0.1-0.2 mg/kg IV repeat PRN OR

Continuous infusion: 0.01-0.012 mg/kg/min IV 

Administration

Dose should be calculated based on ideal body weight

Dosage Forms & Strengths

injectable solution

  • 10mg/mL (5 & 10mL vials)
more...

Tracheal Intubation

< 3 months

  • Safety and efficacy not established

3 months to 14 years

  • Initial: 0.6 mg/kg IV
  • Maintenance: 0.075-0.125 mg/kg IV OR
  • Continuous infusion: 0.012 mcg/kg/min (IV)

> 14 years

  • 0.45-0.6 mg/kg IV
  • Maintenance: 0.1-0.2 mg/kg IV repeat PRN OR
  • Continuous infusion: 0.01-0.012 mg/kg/min IV
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Interactions

Interaction Checker

rocuronium and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Transient hypotension (1-2%)

            Hypertension (1-2%)

            <1%

            Dose-related tachycardia

            Apnea

            Abnormal ECG

            Injection site edema

            Hiccups

            Pruritus

            Nausea

            Wheezing

            Residual muscle weakness

            Allergic or idiosyncratic hypersensitivity reactions

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            Warnings

            Black Box Warnings

            Contraindications

            Hypersensitivity

            Lack of ventilatory support, neuromuscular disease

            Other neuromuscular blocking agents

            Cautions

            Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent

            Administer only by trained individuals familiar with its actions, characteristics, and hazard

            Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken; neuromuscular cross-sensitivity with other nuromuscular blocking agents possible

            Neuromuscular transmission should be monitored continuously during administration and recovery with the help of a nerve stimulator; additional doses of rocuronium or any other neuromuscular blocking agent should not be given until there is a definite response (one twitch of the train-of-four) to nerve stimulation

            Use caution in patients with significant hepatic disease; if used for rapid sequence induction in patients with ascites, an increased initial dosage may be necessary to assure complete block

            Some patients may experience prolonged recovery (paralysis) of neuromuscular function

            Adequate ventilatory support mandatory, may experience resistance with >25% TBSA burns, may experience increased sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)

            When used with other agents, occurrence of malignant hyperthermia during anesthesia is possible even in the absence of known triggering agents; clinicians should be familiar with early signs, confirmatory diagnosis and treatment of malignant hyperthermia prior to initiating any anesthetic

            Conditions associated with slower circulation time, eg, cardiovascular disease or advanced age, may be associated with a delay in onset time; since higher doses of rocuronium bromide injection produce longer duration of action, initial dosage should not be increased in these patients to reduce onset time; instead, when feasible, more time should be allowed for the drug to achieve onset of effect; geriatric patients (65 years or older) may be at increased risk for residual neuromuscular block

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known if excreted in breast milk; effect on nursing infant not known

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Nondepolarizing skeletal muscle relaxant; cholinergic receptor antagonist; inhibits depolarization

            Other Information

            Onset: 1-2 min

            Half-Life: 60-70 min (elimination); About 2x as long in hepatic dysfunction

            Duration: 30 min (0.6 mg/kg dose); 67 min (1.2 mg/kg dose)

            Metabolism: Minimal hepatic metabolism

            Protein binding: 30%

            Vd: 0.25 L/kg

            Excretion: Urine (30%); feces (70%) as active & inactive metabolites & small amounts of unchanged drug

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            Administration

            IV Compatibilities

            Solution: D5W, D5/NS, LR, NS

            Y-site: dexmedetomidine, fenoldopam, Hextend, milrinone

            IV Preparation

            Dilute with D5W or LR to a final concentration of 0.5 or 1 mg/mL for infusion

            IV Administration

            Administer IV only

            May be given undiluted as a rapid injection or via continuous infusion using an infusion pump

            Storage

            Refrigerate 2-8°C; do not freeze

            Intact vials stored at room temp should be used within 60 d

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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