Dosing and uses of Zemuron (rocuronium)
Adult dosage forms and strengths
injectable solution
- 10mg/mL (5 & 10mL vials)
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
Pediatric dosage forms and strengths
injectable solution
- 10mg/mL (5 & 10mL vials)
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
Zemuron (rocuronium) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of Zemuron (rocuronium)
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
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
