Sugammadex: clinical use

Prescribing considerations

• Administration should be by or under an anaesthetist, guided by appropriate neuromuscular monitoring.
• Maintain ventilatory support until adequate spontaneous respiration is established.
• Sugammadex is not recommended in severe renal impairment, including in patients requiring dialysis.
• Use great caution in severe hepatic impairment, particularly with coagulopathy.
• Prepare for hypersensitivity and clinically significant bradycardia.
• Provide and document clear hormonal-contraception counselling.

Contraindications and cautions

• Hypersensitivity to sugammadex or any formulation excipient.
• Do not use to reverse blockade caused by non-steroidal neuromuscular blockers or steroidal blockers other than rocuronium or vecuronium.

Monitoring

• Neuromuscular recovery and recurrence of blockade
• Respiratory function and need for ventilation
• Heart rate, blood pressure and haemodynamic changes
• Hypersensitivity, bronchospasm and signs of light anaesthesia
• Bleeding risk with therapeutic anticoagulation or coagulopathy

Clinical pharmacology

Sugammadex is a modified gamma-cyclodextrin that forms water-soluble complexes with rocuronium and vecuronium. It is eliminated mainly unchanged through the kidneys, and exposure is prolonged as renal function declines.

Formulation and product differences

• The selected product is a clear, colourless to slightly yellow intravenous solution containing sugammadex sodium, water for injections and pH-adjusting agents.
• It contains sodium; assess the product-specific amount when sodium restriction is clinically important.
• Use only listed compatible infusion fluids and flush the intravenous line between incompatible medicines.

Injection

Route: Parenteral

Strengths: 100 mg/mL