Sugammadex

How it works

It is a modified gamma-cyclodextrin that encapsulates circulating rocuronium or vecuronium molecules, forming an inactive complex that is excreted renally and rapidly restores neuromuscular function.

Prescribing in practice

• Hypersensitivity reactions including anaphylaxis can occur, so it should be given where resuscitation facilities are available and the patient observed afterwards.
• It can interact with hormonal contraceptives, equivalent to a missed dose, and additional contraceptive precautions should be advised.
• It reverses only aminosteroid blockers (not benzylisoquinolinium agents) and is used with caution in severe renal impairment owing to reduced clearance.

Monitoring

Confirm adequate recovery of neuromuscular function with a nerve stimulator (train-of-four) and observe for hypersensitivity and re-curarisation.

Counselling the patient

• Advise that hormonal contraception may be made less effective and that additional precautions are needed for a period afterwards.
• Report any rash, swelling or breathing difficulty after administration.

Evidence & guidelines

Its efficacy in rapidly reversing rocuronium- and vecuronium-induced blockade is well established and supported by the SPC and anaesthetic guidance.