Aminosteroid non-depolarising neuromuscular blocker Pregnancy: Limited data in pregnant women; animal studies show no reproductive toxicity. Use only when strictly necessary and benefit outweighs risk. Shown safe at 0.6 mg/kg for Caesarean section (limited placental transfer).

Rocuronium bromide

Brand names: Esmeron

Rocuronium bromide is an intermediate-acting non-depolarising aminosteroid neuromuscular blocking agent used to provide muscle relaxation for tracheal intubation and during surgery.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Tracheal intubation (routine anaesthesia): 0.6 mg/kg IV. Rapid sequence induction: 1.0 mg/kg IV

Route: Intravenous (bolus injection or continuous infusion)

Frequency: Single intubating dose; maintenance 0.15 mg/kg at 25% twitch recovery, or continuous infusion

Individualise dose; use neuromuscular monitoring. Maintenance 0.15 mg/kg (reduce to 0.075-0.1 mg/kg during long-term inhalational anaesthesia); give best when twitch has recovered to 25% or 2-3 TOF responses present. Continuous infusion: loading dose 0.6 mg/kg then infusion 0.3-0.6 mg/kg/h under IV anaesthesia (0.3-0.4 mg/kg/h under inhalational anaesthesia). Caesarean section: use only 0.6 mg/kg (1.0 mg/kg not investigated in this group). Obese/overweight (>=30% above ideal body weight): reduce dose to lean body mass. Doses above 0.9 mg/kg may increase heart rate. If 0.6 mg/kg used for RSI, intubate at 90 seconds.

Paediatric dose

Dose: 0.6 mg/kg

Route: Intravenous

Frequency: Single intubating dose (routine anaesthesia)

Neonates (0-27 days), infants, toddlers, children (2-11 y) and adolescents (12-17 y): routine-anaesthesia intubation dose and maintenance dose similar to adults (maintenance ~0.15 mg/kg). Duration of a single intubating dose is longer in neonates and infants. NOT recommended for rapid sequence induction in paediatric patients (limited experience). For continuous infusion, infusion rates are the same as adults except children may need higher rates.

Dose adjustments

Renal

Renal failure (grouped with hepatic/biliary disease and elderly): standard intubation dose 0.6 mg/kg; maintenance 0.075-0.1 mg/kg; infusion rate 0.3-0.4 mg/kg/h.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to rocuronium, the bromide ion, or any excipient

Side effects

Injection site pain / local reactions (uncommon-rare)
Prolonged neuromuscular block (uncommon-rare)
Tachycardia (uncommon-rare)
Hypotension (uncommon-rare)
Anaphylactic / anaphylactoid reactions (very rare)

Interactions

Inhalational anaesthetics: potentiate neuromuscular block (reduce maintenance/infusion for procedures >1 hour)
Magnesium salts (e.g. for toxaemia of pregnancy): enhance block and may inhibit reversal — reduce dose and titrate to twitch response
Certain antibiotics (aminoglycosides, vancomycin, tetracyclines, polymyxins, colistin), quinidine, lithium, procainamide, local anaesthetics: may enhance/prolong block
Anticonvulsants (carbamazepine, phenytoin): may cause resistance / shorter block, higher infusion rates

Clinical monograph

How it works

It competitively antagonises acetylcholine at nicotinic receptors of the neuromuscular junction, preventing motor end-plate depolarisation and producing reversible skeletal muscle paralysis.

Prescribing in practice

It causes paralysis without sedation or pain relief, so adequate anaesthesia and analgesia must always be ensured throughout its use to prevent awareness; its block can be rapidly reversed with sugammadex.
It is a recognised cause of perioperative anaphylaxis among neuromuscular blocking agents, and resuscitation facilities must be immediately available.
Its duration is prolonged in hepatic impairment and the elderly, and neuromuscular monitoring should confirm adequate recovery before extubation.

Monitoring

Monitor the depth and recovery of neuromuscular block with a peripheral nerve stimulator throughout anaesthesia.

Counselling the patient

This drug temporarily relaxes the muscles for surgery and is given alongside drugs that keep the patient asleep and free of pain.
Breathing is supported by a ventilator while the medicine is working.
A dedicated reversal agent can be used to restore muscle strength when needed.

Evidence & guidelines

Rocuronium is a well-established intermediate-acting neuromuscular blocker, and sugammadex provides rapid, predictable reversal of its block in routine and emergency anaesthetic practice.

Reference: AAGBI; NAP6; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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