Non-Depolarising Neuromuscular Blocking Agent Pregnancy: No adequate and well-controlled studies in pregnant women; animal studies showed no teratogenicity. Use in pregnancy only if potential benefit justifies the potential risk to the fetus.

Rocuronium (Anaesthesia/RSI)

Brand names: Esmeron

Rocuronium used in anaesthesia and rapid sequence induction (RSI) is an intermediate-acting non-depolarising aminosteroid neuromuscular blocker valued for its rapid onset, which makes it suitable for securing the airway quickly.

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: 0.6 mg/kg IV. Rapid sequence intubation: 0.6 to 1.2 mg/kg IV

Route: Intravenous (bolus injection or continuous infusion) — IV use only

Frequency: Single intubating dose; maintenance doses as neuromuscular function recovers, or continuous infusion

Individualise dose; use a peripheral nerve stimulator to monitor block and recovery. Maintenance doses 0.1, 0.15 or 0.2 mg/kg given at 25% recovery of control T1. A lower intubating dose of 0.45 mg/kg may be used; larger bolus of 0.9 or 1.2 mg/kg may be given without cardiovascular adverse effects. Continuous infusion: initial rate 10-12 micrograms/kg/min, started only after early spontaneous recovery from an intubating dose (clinical range 4-16 micrograms/kg/min). Elderly: onset/duration slightly longer. Source: US labelling (openFDA) — verify against a UK SPC.

Dose auto-extracted from 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.

Contraindications

Hypersensitivity (e.g. anaphylaxis) to rocuronium bromide or other neuromuscular blocking agents

Side effects

Transient hypotension
Transient hypertension
Anaphylaxis
Residual paralysis
Myopathy

Interactions

Inhalation anaesthetics (esp. enflurane, isoflurane): enhance neuromuscular block
Certain antibiotics (aminoglycosides, vancomycin, tetracyclines, bacitracin, polymyxins, colistin, sodium colistimethate): enhance/prolong block
Magnesium, lithium, quinidine, procainamide, local anaesthetics: may enhance block
Anticonvulsants (carbamazepine, phenytoin): may reduce/shorten block (resistance)

Clinical monograph

How it works

It competitively blocks nicotinic acetylcholine receptors at the neuromuscular junction to produce skeletal muscle relaxation; at higher RSI doses its onset approaches that of suxamethonium, providing rapid intubating conditions without depolarising muscle.

Prescribing in practice

It provides paralysis with no sedation or analgesia, so it must follow an adequate induction agent and never be given to a conscious patient; failed intubation can be managed because its block can be rapidly reversed with sugammadex.
Anaphylaxis to neuromuscular blockers is a recognised cause of perioperative anaphylaxis, and rocuronium is among the more frequently implicated agents.
Duration is prolonged in hepatic impairment and the elderly; neuromuscular monitoring should guide further dosing and confirm adequate reversal before extubation.

Monitoring

Monitor the neuromuscular block with a peripheral nerve stimulator to time intubation, redosing and reversal.

Counselling the patient

This drug rapidly relaxes the muscles to allow a breathing tube to be placed safely, and is always given after an anaesthetic that ensures the patient is asleep.
A specific reversal agent is available if the block needs to be undone quickly.
Muscle strength is checked before the breathing tube is removed.

Evidence & guidelines

Rocuronium at RSI doses provides intubating conditions comparable to suxamethonium and, with sugammadex available for rapid reversal, is widely used for RSI in current UK anaesthetic practice.

Reference: DAS RSI Guidelines 2015; AAGBI Anaphylaxis Guidelines 2009; AAGBI TOF Monitoring Recommendations; 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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