Rocuronium
A non-depolarizing neuromuscular blocker with fast onset, used for routine and rapid sequence intubation; sugammadex reverses it.
Drug card
- How it works
- Competing with acetylcholine at muscle nicotinic receptors, causing paralysis
- Used for
- Rapid sequence and routine tracheal intubation
- Muscle relaxation during surgery
- Muscle relaxation for mechanical ventilation
- Known for
- Anaphylaxis, sometimes fatal
- Residual paralysis after surgery
- Its name
- -curium, -curonium means a non-depolarizing neuromuscular blocker
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does rocuronium work?
Rocuronium competes with acetylcholine for nicotinic receptors at the motor end-plate. Onset is rapid to intermediate, depending on dose, and duration intermediate. It is excreted in bile and urine, so liver and kidney disease can prolong it. Neostigmine reverses it once recovery starts; sugammadex, a modified γ-cyclodextrin, binds it and reverses even deep block.
Like other non-depolarizing neuromuscular blockers: These drugs bind competitively to the nicotinic acetylcholine receptors of the motor end-plate, so acetylcholine cannot trigger muscle contraction and skeletal muscle is paralyzed. They have no effect on consciousness or pain. Anticholinesterases such as neostigmine, given with atropine or glycopyrrolate, reverse the block by raising acetylcholine; sugammadex reverses rocuronium by binding the drug itself.
Uses
What is rocuronium used for?
- Rapid sequence and routine tracheal intubation
- Muscle relaxation during surgery
- Muscle relaxation for mechanical ventilation
Side effects
Side effects of rocuronium
- Anaphylaxis, sometimes fatalKnown forSerious
- Residual paralysis after surgeryKnown forSerious
- Pain at the injection site
- Brief low blood pressure
- Brief high blood pressure
- Fast heart rate and arrhythmias
- Bronchospasm and wheezeSerious
- Itching and rash
- Myopathy after long ICU use with steroidsSerious
- Long QT with general anesthetics in children
- Nausea and vomiting
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- It has no effect on consciousness or pain: always give it with adequate anesthesia or sedation.
- Give only with intubation, ventilation and a reversal agent ready, and monitor with a nerve stimulator.
- Aminoglycosides, magnesium, lithium, inhaled and local anesthetics prolong the block; long-term anticonvulsants shorten it.
- Cross-reactivity is possible in anyone who has had anaphylaxis to another neuromuscular blocker.
Good to know: Its fast onset suits rapid sequence intubation, and sugammadex, which binds it, can reverse it even from deep block.
Remember it
A way to remember it
Compete, then reverse: neostigmine floods the end-plate with acetylcholine.
These blockers only compete with acetylcholine at the nicotinic receptor. Neostigmine blocks acetylcholinesterase, so acetylcholine builds up and wins the receptors back; sugammadex instead binds rocuronium itself.
Written for biofideX
Its name
-curium, -curonium means non-depolarizing neuromuscular blocker
-curonium names (rocuronium, vecuronium) are steroid-based, and sugammadex reverses them. Atracurium (-curium) breaks down in plasma by Hofmann elimination and ester hydrolysis.
- Every drug name stem
Its class
Non-depolarizing neuromuscular blockers
Other non-depolarizing neuromuscular blockers with a card:
Easily mixed up with depolarizing neuromuscular blockers and anticholinesterases.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Rocuronium bromide injection: label (DailyMed)
- Rocuronium bromide 10 mg/ml solution for injection/infusion: SmPC (emc)
- Sugammadex injection: label (DailyMed)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Anesthesia and muscle relaxants
Rocuronium is one of 8 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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