๐ About
Always check the BNF entry for Sugammadex here for the latest dosing and safety updates.
It is a revolutionary agent in anaesthetic pharmacology, offering rapid and reliable reversal of neuromuscular blockade caused by aminosteroid relaxants.
โ๏ธ Mode of Action
- ๐งฌ Sugammadex is a modified ฮณ-cyclodextrin that encapsulates aminosteroid neuromuscular blockers such as rocuronium and vecuronium.
- ๐ It forms a tight 1:1 complex with the drug molecule, chelating the free rocuronium/vecuronium in plasma.
- โฌ๏ธ This creates a concentration gradient โ the drug diffuses from the neuromuscular junction back into plasma, reducing receptor blockade and restoring muscle tone.
- โก The complex has a very high affinity and very low dissociation rate, so the captured aminosteroid is not released back into circulation.
- ๐ฝ Excreted unchanged in urine โ hence caution in renal impairment.
๐ฆ Indications & Doses
- ๐ถ Children (2โ17 years): 2 mg/kg for routine reversal of rocuronium-induced block.
- ๐ฉโโ๏ธ Adults:
- ๐จ Immediate reversal (after large rocuronium dose): 16 mg/kg.
- โฌ๏ธ Deep block: 4 mg/kg for rocuronium or vecuronium.
- ๐ช Moderate block: 2 mg/kg for rocuronium or vecuronium.
- ๐ Repeat 4 mg/kg if re-paralysis occurs.
โ ๏ธ Interactions
- ๐ Oral contraceptives: Sugammadex binds steroid molecules and can reduce contraceptive efficacy.
Patients should follow the โmissed pillโ protocol for their specific preparation or use backup contraception for 7 days.
๐ฉบ Cautions
- โณ Delayed recovery possible in elderly or those with cardiovascular disease.
- ๐ซ Re-use of rocuronium should be avoided for 24 hours post-sugammadex (drug remains bound and inactive).
- ๐ฉธ May slightly increase risk of post-operative bleeding โ mechanism thought to involve mild coagulation changes.
โ Contraindications
- โ๏ธ Severe renal impairment: avoid if creatinine clearance < 30 mL/min (due to reliance on renal excretion).
๐ข Side Effects
- ๐คข Common: vomiting, dry mouth, dizziness, tachycardia.
- ๐จ Serious (rare): hypersensitivity, anaphylaxis, or bronchospasm.
๐ References
- Nag K, Singh DR, Shetti AN, Kumar H, Sivashanmugam T, Parthasarathy S. Sugammadex: A revolutionary drug in neuromuscular pharmacology. Anesthesia, Essays and Researches (2013) 7(3):302โ306. DOI:10.4103/0259-1162.123211
- Chang HW, Lee IO, Kang H, Won YJ, Lim YS. Coagulation Effect of Sugammadex as Determined by Thromboelastography. Int J Med Sci (2021) 18(6):1318โ1324. DOI:10.7150/ijms.42563
๐ก Teaching tip:
Sugammadex offers rapid, predictable reversal โ far faster than neostigmine and without muscarinic side effects.
However, its cost, renal dependence, and steroid interactions make BNF consultation essential before use.
