Sugammadex Administration Guide

SUGAMMADEX 200 MG / 2 ML INJECTION
Route	Dilution	Infusion Rate
Reconstitution	Not required  1
INTRAVENOUS INJECTION	Single bolus injection into an existing IV line 1 ü   Adult: Pure ü   Paediatrics: May dilute (refer ‘to Diluent’ section)	Rapidly within 10 seconds 1,3,4   However, some experts suggest administering slow IV push to reduce incidence of serious adverse events (e.g. bradycardia or asystole), e.g. in older patients 3,4
DILUENT	·       May be injected into the intravenous line of a running infusion with NS / D5 / Ringer’s Lactate / Ringer’s Solution / NSD5 / NaCl 0.45% + Glucose 2.5% 1,4 ·       The infusion line should be adequately flushed with NS (NaCl 0.9%) between administration of Sugammadex and other drugs. 1,4 ·       For paediatric patients, to increase accuracy of dosing, may dilute with NS to: ü  10 mg/mL concentration for 2 years old and above 1 ü  25 mg/mL concentration for below 2 years old 3
Stability	Original Intact Product Store in the original package to protect from light 1 The vials may be stored outside the carton for up to 5 days 1,4   Diluted Product §   Under aseptic condition: Diluted product: 48 hrs at 2-25°C 1 §   NOT under aseptic condition: Diluted product: 24 hrs at 2-8°C 1
RECOMMENDED DOSE	Dosing in geriatrics: Same as adult dose 1,3 Dosing in obesity: Use actual body weight 1,4   Indication 1,2 Adult Dose Paeds Dose (For 2 years old & above) Spontaneous recovery has occurred up to at least the reappearance of second twitch tension of the train-of-four (T2) 2 mg/kg 1-4 2 mg/kg 1,3 Recovery has reached at least 1- 2 post-tetanic counts (PTC) 4 mg/kg 1-4 Not recommended as no data 1 Immediate reversal following administration of rocuronium 16 mg/kg 1-4   Recommended waiting times for readministration with neumomuscular blocking agents (NMBA) after reversal with Sugammadex: Dose of Sugammadex Administered Minimum Waiting Time NMDA and Dose to be Administered After routine reversal with up to 4 mg/kg sugammadex 5 mins 1.2 mg/kg rocuronium 4 hrs 0.6 mg/kg rocuronium  OR  0.1 mg/kg vecuronium After immediate reversal with 16 mg/kg sugammadex 24 hrs -
Remarks	·       Physical incompatibility reported with ranitidine, verapamil & ondansetron.1 ·       Very common side effects include hypotension, headache, nausea, vomiting and procedural pain / pain at injection site. 3,4
References	1.     Product Leaflet (BRIDION ; Revised Jan 2017) 2.     FUKKM online: Sugammadex [Accessed 18 March 2021] 3.     Uptodate [online]: Sugammadex [Accessed on 18 March 2021] 4.     Micromedex Version v3.0b856 [Accessed 18 March 2021]

 

Prepared by J. Ho [18.03.2021]