|Trade names||Zemuron, Esmeron, others|
|Other names||Rocuronium bromide, [3-hydroxy-10,13-dimethyl-2-morpholin-4-yl-16-(1-prop-2-enyl-2,3,4,5-tetrahydropyrrol-1-yl)-2,3,4,5,6,7,8,9,11,12,14,15,16,17-tetradecahydro-1H-cyclopenta[a]phenanthren-17-yl] acetate|
|Drug class||Neuromuscular blocker|
|Onset of action||60 secs|
|Duration of action||25 to 90 mins|
|Typical dose||1.2 mg/kg|
|Elimination half-life||66–80 minutes|
|Excretion||Unchanged, in bile and urine|
|Chemical and physical data|
|Molar mass||609.690 g·mol−1|
|3D model (JSmol)|
|(what is this?)|
Rocuronium, sold under a number of brands, is a medication used to paralyze muscles for endotracheal intubation, including rapid sequence induction (RSI). It may also be used to relax muscles during surgery and when people are on a ventilator. It is given by injection into a vein. A single dose begins working after about 45 to 120 seconds and lasts for 25 to 90 minutes.
Common side effects include low blood pressure and high blood pressure. Other serious side effects may include anaphylaxis and prolonged muscle weakness. While not well studied in pregnancy, no harms have been found. Breastfeeding shortly following use is likely okay. Rocuronium is a neuromuscular blocker of the non-depolarizing type.
Rocuronium was approved for medical use in the United States in 1994. It is avaliable as a generic medication. In the United States it costs about 40 USD for 500 mg as of 2020. In the United Kingdom this amount costs the NHS about 25 pounds. Rocuronium is stable at room temperature for about 12 weeks.
It should only be used with appropriate sedation.
In those who are obese doses should be based on ideal body weight rather than actual body weight.
The dosage does not need to be changed in those with kidney problems. Though lower doses may be required in those with liver problems with prolonged use. Larger doses may be needed in people with large area burn and those with liver problems.
Mechanism of action
It was designed to be a weaker antagonist at the neuromuscular junction than pancuronium; hence its monoquaternary structure and its having an allyl group and a pyrrolidine group attached to the D ring quaternary nitrogen atom. Rocuronium has a rapid onset and intermediate duration of action.
There is considered to be a risk of allergic reaction to the drug in some patients (particularly those with asthma), but a similar incidence of allergic reactions has been observed by using other members of the same drug class (non-depolarizing neuromuscular blocking drugs).
The γ-cyclodextrin derivative sugammadex has been recently introduced as a novel agent to reverse the action of rocuronium. Sugammadex has been in use since 2009 in many European countries; however, it was turned down for approval twice by the US FDA due to concerns over allergic reactions and bleeding, but finally approved the medication for use during surgical procedures in the United States on December 15, 2015. Neostigmine can also be used as a reversal agent of rocuronium but is not as effective as sugammadex. Neostigmine is often still used due to its low cost compared with sugammadex.
It was introduced in 1994, and is marketed under the trade name of Zemuron in the United States and Esmeron in most other countries.
On 3 October 2016, the U.S. state of Ohio announced that it would resume executions on January 12, 2017, using a combination of midazolam, rocuronium bromide, and potassium chloride. Prior to this, the last execution in Ohio was in January 2014.
- "Rapid sequence intubation - WikEM". wikem.org. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- "Succinylcholine vs. Rocuronium: Battle of the RSI Paralytics". JEMS. 14 May 2019. Retrieved 28 September 2020. CS1 maint: discouraged parameter (link)
- "Rocuronium Bromide Monograph for Professionals". Drugs.com. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- Tran, DT; Newton, EK; Mount, VA; Lee, JS; Wells, GA; Perry, JJ (29 October 2015). "Rocuronium versus succinylcholine for rapid sequence induction intubation". The Cochrane Database of Systematic Reviews. 10 (10): CD002788. doi:10.1002/14651858.CD002788.pub3. PMC 7104695. PMID 26512948.
- Jain, Ankit; Wermuth, Harrison R.; Maani, Christopher V. (2020). "Rocuronium". StatPearls. StatPearls Publishing. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- "Rocuronium (Zemuron) Use During Pregnancy". Drugs.com. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- "Rocuronium". Drugs and Lactation Database (LactMed). National Library of Medicine (US). 2006. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- "Rocuronium - WikEM". wikem.org. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- "Rocuronium (Zemuron) | Davis's Drug Guide". nursing.unboundmedicine.com. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- BNF 79. London: Pharmaceutical Press. March 2020. p. 1379. ISBN 978-0857113658.
- "Rocuronium Prices, Coupons & Patient Assistance Programs". Drugs.com. Retrieved 19 August 2020. CS1 maint: discouraged parameter (link)
- Hunter JM (April 1996). "Rocuronium: the newest aminosteroid neuromuscular blocking drug". British Journal of Anaesthesia. 76 (4): 481–3. doi:10.1093/bja/76.4.481. PMID 8652315.
- Burburan SM, Xisto DG, Rocco PR (June 2007). "Anaesthetic management in asthma". Minerva Anestesiologica. 73 (6): 357–65. PMID 17115010.
- Naguib M (March 2007). "Sugammadex: another milestone in clinical neuromuscular pharmacology". Anesthesia and Analgesia. 104 (3): 575–81. doi:10.1213/01.ane.0000244594.63318.fc. PMID 17312211.
- McKee, Selina (September 24, 2013). "FDA turns down Merck & Co's sugammadex again". PharmaTimes. Archived from the original on February 22, 2014. CS1 maint: discouraged parameter (link)
- "Press Announcements - FDA approves Bridion to reverse effects of neuromuscular blocking drugs used during surgery". www.fda.gov. Retrieved 2017-01-07.
- Carron, Michele; Zarantonello, Francesco; Tellaroli, Paola; Ori, Carlo (2016). "Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials". Journal of Clinical Anesthesia. 35: 1–12. doi:10.1016/j.jclinane.2016.06.018. PMID 27871504.
- "Virginia Department of Corrections Operating Procedure: Execution Manual" (PDF). 2017-02-07. Retrieved 2017-10-25.
- "Ohio to resume executions using a three-drug combination in January". BBC News. 2016-10-03. Retrieved 2017-01-07.
- Jason Dearon. "Florida executes convicted killer Mark Asay using new drug". Sun Sentinel.