Rocuronium (Intravenous)

Rocuronium is sold under the brand name Zemuron, and it used during anesthesia to keep patients still or to help relax the muscles of the throat during intubation.

Overview

Rocuronium is an injectable form of medication that is used intravenously. The drug is only used when a patient is in a medical setting. It is not intended to treat a specific condition or to diagnose any conditions. Rocuronium is used when a patient is undergoing anesthesia during a surgery or a procedure. It may also be used when a patient needs to be intubated so that a breathing tube can be inserted for the purpose of mechanical breathing. It may also be used to help pass a tube down the esophagus.

Rocuronium has several side effects that would need to be monitored while the drug is being administered. Since the drug is always given in a medical setting, the medical staff will continuously asses the patient and deal with side effects if they become evident or problematic.

This drug has many different drug interactions. It is imperative that patients discuss each type of drug that they are taking whether it be a prescription or nonprescription drug. Patients should also advise their doctor regarding any supplements that they are taking.

Rocuronium acts rapidly once it is infused in the body. The drug acts by causing rapid muscle relaxation. It acts by blocking the signals from the nervous system to the muscles. This allows the body to remain still during procedures, and it allows the muscles of the throat to relax enough to accept a tube down the throat.

Conditions Treated

Rocuronium is not used to treat any specific diseases. It is used to assist with anesthesia and intubation. Some conditions that may require intubation include:

  • General anesthesia for surgery
  • Collapsed lung
  • Lack of oxygen
  • Damage to nervous system preventing intake of air
  • Gastrointestinal diagnostic procedures

Type of Medicine

  • Rapid onset muscle relaxant.

Side Effects

As with most drugs, there are several side effects that have been reported when rocuronium is administered. Patients should note that this drug is only administered by trained medical professionals, and the drug will only be used in a medical setting. Any side effects that might occur during administration will be monitored and addressed by the medical team.

The most serious side effects that are known to occur when rocuronium is administered are systemic allergic reactions. These type of reactions may cause difficulty with breathing. Hives and eczema may be noted on parts of the body. The patient may experience swelling of the face, the lips and the throat. These type of side effects are rare.

More common side effects that occur with the drug include a headache while the drug is being administered. Some patients report that they feel light headed and feel as if they may pass out. In some patients, this lightheadedness and headache are the result of rocuronium elevating the patient's blood pressure.

There are other side effects with this drug that are more uncommon. Some patients have reported a slow and irregular heartbeat when rocuronium is administered. Tightness and pain in the chest has also been reported. There have been some breathing problems associated with the drug. Some patients reported an increase in coughing, while other patients have developed a particularly noisy type of breathing while rocuronium was in their system.

A few patients have reported difficulty in swallowing as a result of using this drug. However, this drug is often used when intubation occurs. Difficulty in swallowing is often noted as a side effect of having been intubated. Doctors are unsure if this difficulty in swallowing is a side effect of the drug or of the intubation procedure.

There is one generally noted side effect of rocuronium that occurs when the patient has gone home or after the procedure is completed. Patients have reported pain and swelling at the site where rocuronium was injected into the body. These type of infusion side effects are common with many intravenous drugs. There is usually no long term problem associated with this type of side effect.

Dosage

The dosage of rocuronium depends on the procedure for which it is being used. If the drug is being used for tracheal intubation, the normal dosage of the drug is .06 mg per kg for a period of one minute. This dosage provides approximately 30 minutes of relaxation of the muscles.

If the drug is used during a full surgical procedure, it is given by continuous infusion. This infusion rate is based upon the weight of the patient, so there will be great variations in how much of the drug is administered.

Interactions

Rocuronium interacts with many different medications. Some of the interactions are more serious than others. Twenty-eight different drugs are known to have serious interactions with rocuronium. The following drugs and rocuronium should not be used together.

  • Amikacin
  • Amphotericin b deoxycholate
  • Capreomycin
  • Clindamycin
  • Colistin
  • Demeclocycline
  • Doxycycline
  • Fentanyl
  • Fentanyl intranasal
  • Fentanyl iontophoretic transdermal system
  • Fentanyl transdermal
  • Fentanyl transmucosal
  • Gentamicin
  • Kanamycin
  • Lincomycin
  • Lymecycline
  • Minocycline
  • Neomycin po
  • Netilmicin
  • Oxytetracycline
  • Paromomycin
  • Polymyxin b
  • Pramlintide
  • Quinine
  • Streptomycin
  • Tetracycline
  • Tobramycin
  • Valerian

Over 100 different drugs cause complications when administered with rocuronium. The doctor and medical team must monitor the patient closely when the following drugs are used with rocuronium.

  • Abobotulinumtoxina
  • Aclidinium
  • Ambenonium
  • Amisulpride
  • Amitriptyline
  • Amoxapine
  • Anticholinergic/sedative combos
  • Aripiprazole
  • Atracurium
  • Atropine
  • Atropine iv/im
  • Bambuterol
  • Belladonna alkaloids
  • Belladonna and opium
  • Benperidol
  • Betamethasone
  • Bethanechol
  • Buclizine
  • Carbachol
  • Cevimeline
  • Chlorpromazine
  • Cisatracurium
  • Clomipramine
  • Clozapine
  • Corticotropin
  • Cortisone
  • Cyclizine
  • Cyclobenzaprine
  • Darifenacin
  • Deflazacort
  • Desipramine
  • Dexamethasone
  • Dicyclomine
  • Diphenhydramine
  • Distigmine
  • Donepezil
  • Dosulepin
  • Doxapram
  • Doxepin
  • Droperidol
  • Echothiophate iodide
  • Edrophonium
  • Fesoterodine
  • Flavoxate
  • Fludrocortisone
  • Fluphenazine
  • Fosphenytoin
  • Galantamine
  • Glycopyrrolate
  • Glycopyrrolate inhaled
  • Haloperidol
  • Henbane
  • Homatropine
  • Huperzine a
  • Hydrocortisone
  • Hyoscyamine
  • Hyoscyamine spray
  • Iloperidone
  • Imipramine
  • Incobotulinumtoxina
  • Ipratropium
  • Lofepramine
  • Loxapine
  • Loxapine inhaled
  • Magnesium sulfate
  • Maprotiline
  • Meclizine
  • Mepenzolate
  • Methscopolamine
  • Methylprednisolone
  • Mianserin
  • Neostigmine
  • Nortriptyline
  • Olanzapine
  • Onabotulinumtoxina
  • Orphenadrine
  • Oxybutynin
  • Oxybutynin topical
  • Oxybutynin transdermal
  • Oxycodone
  • Paliperidone
  • Pancuronium
  • Perphenazine
  • Phenytoin
  • Physostigmine
  • Pilocarpine
  • Pilocarpine ophthalmic
  • Pimozide
  • Pralidoxime
  • Prednisolone
  • Prednisone
  • Prochlorperazine
  • Promethazine
  • Propantheline
  • Protriptyline
  • Pyridostigmine
  • Quetiapine
  • Rapacuronium
  • Rimabotulinumtoxinb
  • Risperidone
  • Scopolamine
  • Sertindole
  • Sevoflurane
  • Solifenacin
  • Succinylcholine
  • Sulpiride
  • Tacrine
  • Thioridazine
  • Thiothixene
  • Tiotropium
  • Tobramycin inhaled
  • Tolterodine
  • Trazodone
  • Triamcinolone
  • Trifluoperazine
  • Trimipramine
  • Trospium chloride
  • Tubocurarine
  • Vecuronium
  • Ziprasidone
  • Zotepine

Several other drugs have what are regarded as minor interactions with rocuronium. These drugs include the following.

  • Acetazolamide
  • Amlodipine
  • Carbamazepine
  • Clevidipine
  • Clonazepam
  • Diazepam
  • Diltiazem
  • Dimenhydrinate
  • Donepezil
  • Enflurane
  • Eslicarbazepine acetate
  • Ethosuximide
  • Felbamate
  • Felodipine
  • Gabapentin
  • Gabapentin enacarbil
  • Galantamine
  • Isradipine
  • Lacidipine
  • Lacosamide
  • Lamotrigine
  • Lercanidipine
  • Levetiracetam
  • Lithium
  • Lorazepam
  • Methsuximide
  • Nicardipine
  • Nifedipine
  • Nisoldipine
  • Oxcarbazepine
  • Phenobarbital
  • Primidone
  • Quinidine
  • Rufinamide
  • Sultiame
  • Tacrine
  • Thiamine
  • Tiagabine
  • Topiramate
  • Valproic acid
  • Verapamil
  • Zonisamide

Warnings

This drug may cause myopathy if it is used extensively during a long stay in an intensive care unit. This myopathy may include damage to the heart muscle.

Patients who have reduced liver functions should be given this drug with extreme caution. Patients with hepatic disease may require more of the drug to achieve the desired results. It may take these patients longer to expel the drug from their systems.

Those with cardiovascular problems should be closely monitored while using rocuronium. Using rocuronium may worsen conditions such as pulmonary hypertension, heart vessel disease, heart valve problems and heart rhythm problems.

Rocuronium is known to worsen the symptoms of those who have the autoimmune disorder myasthenia gravis.

This drug has not been adequately tested on children. This drug is not recommended for use in children.

This drug is rated as pregnancy category C. The drug has not been tested extensively in pregnant patients. Caution should be used when it is administered to pregnant women.

If using this drug in geriatric patients, caution must be exercised. Elderly patients may take longer to recover from the drug's effects.

Storage

This drug should be stored in a refrigerator between the temperature of 36 and 46 degrees Fahrenheit. Patients need not be concerned about the storage of the drug as it is only stored and used in a medical facility.

Summary

Rocuronium is a drug used to relax muscles when anesthesia is given. It is also used during intubation. The drug is not designed to treat any diseases or conditions.

Rocuronium has many drug interactions. It is very important for patients to tell their medical provider about all the medicines that they are taking both prescription and nonprescription drugs.

The side effects with this drug are usually rare. Since the drug is administered in a medical setting, the side effects will be monitored and controlled by the medical staff. The only side effect that most patients will encounter after a procedure relate to pain and swelling at the injection site. This is usually mild.

Patients with reduced liver function, cardiac conditions and myasthenia gravis should be monitored closely when this drug is administered as it may worsen these conditions.

This drug has not been tested in pregnant women, and therefore it should be used with caution in these patients.

 

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Last Reviewed:
January 31, 2018
Last Updated:
April 05, 2018