Sugammadex is Coming !

Our hospital is finally getting Sugammadex. I am so thrilled that we have something else to use to quickly reverse patients other than neostigmine. I figure it it time to write a post about the medication to give you a quick summary of what the drug is, how it works, and the side effects etc.




As we can see from the figure above, sugammadex acts like a pacman. It binds to rocuronium/vecuronium and encapsulates the molecule. The 1:1 binding forms  cyclodextrin. This reduces the amount of free NMB agent in plasma. Subsequently the concentration gradient favors movement of NMB agent away from the neuromuscular junction

  • Used for adults undergoing surgery for the reversal of neuromuscular blockade (NMB) induced by rocuronium or vecuronium
  • Not indicated to reverse blockade of nonsteroidal neuromuscular blocking agents (eg, succinylcholine)

Because the structure of the sugammadex is similar to estrogen and studies have found that the efficacy of hormonal contraceptives is being affected. Therefore it is recommend that additional, non-hormonal method of contraception for next 7 days. In addition, interactions with toremifene has been found and the recovery can be delayed.

It is contraindicated if patient develops hypersensitivity to sugammadex or any component of the product.  In addition, use is not recommended with severe renal impairment or dialysis-dependent patients. Caution should be given to patient who has mild-to-moderate renal impairment. No dose adjustment though because it is based on 1:1 binding to NMB agent.

Common dose is 2-4mg/kg based on actual body weight depending on blockade status. 16mg/kg is recommended by the manufacturer if emergent reversal is required.

Common side effects are N/V. Rare complications involve HOTN, Bradycardia and QT prolongation.

Considering the latest shortage of neostigmine and price hike on the drug, sugammadex is exactly what we have been waiting for.

Thank you for reading and if you have specific topics you would like to discuss, please let me know.


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