Intravenous Facilitate endotracheal intubation, Muscle relaxant in general anaesthesia
Adult: During routine induction: Initially, 0.6 mg/kg via IV inj. During rapid induction of anaesthesia: 1 mg/kg via IV inj. Maintenance dose: 0.15 mg/kg via IV inj; reduce to 0.075-0.1 mg/kg in case of prolonged inhalational anaesthesia. Alternative maintenance dose: 0.3-0.6 mg/kg/hour via continuous IV infusion. Individualise dosage according to the method of anaesthesia or sedation, expected duration of surgery or mechanical ventilation, potential interactions with concomitantly administered medications, and patient's overall condition. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: During routine and rapid induction of anaesthesia: Initially, 0.6 mg/kg via IV inj. Maintenance dose: 0.075-0.1 mg/kg via IV inj. Alternative maintenance dose: 0.3-0.4 mg/kg/hour via continuous IV infusion. Individualise dosage according to the method of anaesthesia or sedation, expected duration of surgery or mechanical ventilation, potential interactions with concomitantly administered medications, and patient's overall condition. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: During routine induction: Initially, 0.6 mg/kg via IV inj. Maintenance dose: 0.15 mg/kg via IV inj; reduce to 0.075-0.1 mg/kg in case of prolonged inhalational anaesthesia. For continuous IV infusion, higher infusion rates may be necessary. Individualise dosage according to the method of anaesthesia or sedation, expected duration of surgery or mechanical ventilation, potential interactions with concomitantly administered medications, and patient's overall condition. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Intravenous Facilitate mechanical ventilation in intensive care
Adult: Initially, 0.6 mg/kg via IV inj. Maintenance dose: 0.3-0.6 mg/kg/hour via continuous IV infusion during the 1st hour of administration, then reduce the rate on the subsequent 6-12 hours according to response. Individualise dosage according to the method of sedation, expected duration of mechanical ventilation, potential interactions with concomitantly administered medications, and patient's overall condition. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
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Overweight or obese patients (weighing ≥30% of their ideal body weight): Reduce and calculate dose based on the ideal body weight.
Renal Impairment
Facilitate endotracheal intubation; Muscle relaxant in general anaesthesia:
In patients with renal failure: During routine and rapid induction of anaesthesia: Initially, 0.6 mg/kg via IV inj. Maintenance dose: 0.075-0.1 mg/kg via IV inj. Alternative maintenance dose: 0.3-0.4 mg/kg/hour via continuous IV infusion. Individualise dosage according to the method of anaesthesia or sedation, expected duration of surgery or mechanical ventilation, potential interactions with concomitantly administered medications, and patient's overall condition. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Hepatic Impairment
Facilitate endotracheal intubation; Muscle relaxant in general anaesthesia:
In patients with hepatobiliary disease: During routine and rapid induction of anaesthesia: Initially, 0.6 mg/kg via IV inj. Maintenance dose: 0.075-0.1 mg/kg via IV inj. Alternative maintenance dose: 0.3-0.4 mg/kg/hour via continuous IV infusion. Individualise dosage according to the method of anaesthesia or sedation, expected duration of surgery or mechanical ventilation, potential interactions with concomitantly administered medications, and patient's overall condition. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Reconstitution
IV infusion: Dilute using a compatible IV solution (e.g. NaCl 0.9%, dextrose 5% water) to make a final concentration of up to 5 mg/mL.
Hypersensitivity to rocuronium bromide or other neuromuscular blocking agents.
Special Precautions
Patient with CV disorders (e.g. valvular heart disease, heart failure), burn injury, pulmonary hypertension, respiratory disease; conditions that may increase paralysis (potentiate neuromuscular blockade) such as neuromuscular diseases, myasthenia gravis, myasthenic (Eaton-Lambert) syndrome, respiratory acidosis, metabolic acidosis, cachexia, or electrolyte abnormalities (e.g. hypermagnesaemia, severe hypokalaemia or hypocalcaemia); conditions that may decrease paralysis (antagonise neuromuscular blockade) such as respiratory alkalosis, peripheral neuropathies, demyelinating lesions, denervation, muscle trauma, or hypercalcaemia. Overweight or obese patients. Patient undergoing surgery with hypothermic conditions. Patient must be mechanically ventilated during treatment until spontaneous breathing has been adequately restored. Hepatic (particularly in patients with hepatobiliary disease) and renal (particularly in patients with renal failure) impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Residual curarisation, increased pulmonary vascular resistance; prolonged paralysis and/or muscle weakness, myopathy (particularly long-term use). Cardiac disorders: Tachycardia. General disorders and administration site conditions: Inj site pain or reaction. Investigations: Changes in vital signs. Vascular disorders: Transient hypotension, hypertension. Potentially Fatal: Severe anaphylactic reactions (e.g. bronchospasm, CV changes, cutaneous changes).
Evaluate patient for intubation difficulties before treatment. Monitor the degree of neuromuscular blockade and recovery using a peripheral nerve stimulator, or the degree of muscle paralysis (e.g. presence of spontaneous movement, ventilator asynchrony, shivering) during treatment; vital signs (e.g. heart rate, blood pressure, respiratory rate).
Overdosage
Symptoms: Prolonged paralysis, apnoea, low tidal volume, respiratory depression and/or persistend muscle weakness. Management: Maintain patent airway, controlled ventilation and adequate sedation. Administer sugammadex to reverse intense (total) and deep blockade. May give acetylycholinesterase inhibitor (e.g. neostigimine, edrophonium, pyridostigmine) once spontaneous recovery has started. Continue ventilation until spontaneous breathing is restored.
Drug Interactions
Enhanced neuromuscular blockade with magnesium salts, halogenated volatile anaesthetics, corticosteroids (long-term use), aminoglycosides, polypeptide antibiotics, lincosamide, acylaminopenicillin antibiotics, diuretics, quinidine, procainamide, calcium channel blockers, lithium salts, local anaesthetics (e.g. IV lidocaine and epidural bupivacaine); β-receptor blocking drugs and phenytoin (acute administration). Decreased neuromuscular blockade with corticosteroids, phenytoin, carbamazepine, and protease inhibitors (e.g. gabexate, ulinastatin). May result in potentiation or attenuation of neuromuscular blockade with non-depolarising neuromuscular blocking agents and suxamethonium.
Action
Description: Mechanism of Action: Rocuronium bromide is a fast-onset, intermediate-acting, non-depolarising neuromuscular blocking agent, which inhibits depolarisation by blocking acetylcholine from binding to receptors on motor endplate. Onset: Within 45 seconds to 3 minutes (good intubation conditions). Duration: Approx 20-120 minutes (dose dependent). Pharmacokinetics: Distribution: Volume of distribution: 0.25 L/kg. Plasma protein binding: Approx 30%. Metabolism: Minimally metabolised in the liver into 17-desacetylrocuronium. Excretion: Via faeces (50-75%); uring (up to 33%). Elimination half-life: 1-2 minutes (alpha); 1.4-2.4 hours (beta).
Chemical Structure
Rocuronium bromide Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 441351, Rocuronium Bromide. https://pubchem.ncbi.nlm.nih.gov/compound/Rocuronium-Bromide. Accessed June 26, 2025.
Storage
Intact vials: Store between 2-8°C. Do not freeze. Diluted solution for IV Infusion: Stable for 24 hours at room temperature. Storage recommendations may vary between individual products (refer to specific product guidelines).
M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
References
Brayfield A, Cadart C (eds). Rocuronium Bromide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2025.Joint Formulary Committee. Rocuronium Bromide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2025.Paediatric Formulary Committee. Rocuronium Bromide. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 09/06/2025.Pfizer New Zealand Limited. DBL Rocuronium Bromide Injection data sheet 10 June 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 03/06/2025.Rocuronium Bromide 10 mg/mL Solution for Injection/Infusion (Ibigen Srl). MHRA. https://products.mhra.gov.uk. Accessed 03/06/2025.Rocuronium Bromide 10 mg/mL Solution for Injection/Infusion (Noridem Enterprises Limited). MHRA. https://products.mhra.gov.uk. Accessed 03/06/2025.Rocuronium Bromide Injection (Civica, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/06/2025.Rocuronium Bromide. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/06/2025.Rocuronium Kabi 10 mg/mL Solution for Injection/Infusion (Fresenius Kabi Malaysia Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 03/06/2025.Rocuronium. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 09/06/2025.Rocuronium. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 03/06/2025.Rocuronium. UpToDate Lexidrug, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/06/2025.
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