Neuromuscular Blockade Reversal Pregnancy: No clinical data in pregnancy; animal studies show no direct/indirect harmful effects. Exercise caution when administering to pregnant women.

Sugammadex

Brand names: Bridion

Sugammadex is a selective relaxant-binding agent used to reverse neuromuscular blockade produced by the aminosteroid agents rocuronium and vecuronium.

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: Routine reversal of rocuronium- or vecuronium-induced blockade: 4 mg/kg IV if recovery has reached 1-2 post-tetanic counts (PTC); 2 mg/kg IV if spontaneous recovery has reached reappearance of T2.

Route: Intravenous single bolus injection (given rapidly, within 10 seconds, into an existing IV line)

Frequency:

Max: Immediate reversal of rocuronium-induced blockade: 16 mg/kg IV

eMC (Bridion). Should be given only by/under supervision of an anaesthetist with neuromuscular monitoring. Dose depends on depth of block, not on anaesthetic regimen. Immediate reversal 16 mg/kg is for rocuronium only (no data for vecuronium). Re-administration: repeat dose of 4 mg/kg if neuromuscular blockade recurs post-operatively. Dose based on actual body weight, including obese/morbidly obese patients. Not recommended in severe renal impairment (CrCl <30 mL/min, including dialysis).

Paediatric dose

Dose: 4 mg/kg

Route: Intravenous single bolus injection

Frequency: Single dose; 4 mg/kg for routine reversal of rocuronium-induced blockade at 1-2 PTC, or 2 mg/kg at reappearance of T2

Max: Immediate reversal not investigated in the paediatric population

eMC: paediatric population birth to 17 years for routine reversal of rocuronium-induced blockade (US label established for ages 2 years and older). Bridion 100 mg/mL may be diluted to 10 mg/mL to improve dosing accuracy. Verify against a children's formulary.

Dose adjustments

Renal

Mild/moderate renal impairment (CrCl >=30 and <80 mL/min): same dose as adults with normal renal function. Severe renal impairment (CrCl <30 mL/min, including dialysis): use not recommended.

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 sugammadex or to any of the excipients

Side effects

Cough
Airway complication of anaesthesia / anaesthetic complications (light anaesthesia)
Procedural hypotension
Marked bradycardia (occasionally cardiac arrest) within minutes of administration
Hypersensitivity reactions including anaphylaxis; (US common: vomiting, nausea, headache, pain)

Interactions

Toremifene: may delay recovery (displacement of rocuronium/vecuronium from the complex)
Hormonal contraceptives: a bolus dose is equivalent to a missed dose - use an additional non-hormonal contraceptive method for 7 days
Pharmacodynamic interaction (aPTT/PT prolongation) noted in vitro with vitamin K antagonists, heparins, rivaroxaban, dabigatran - caution with therapeutic anticoagulation, especially at 16 mg/kg

Clinical monograph

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.

Reference: AAGBI/RCoA Neuromuscular Block Guidelines; 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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