Rocuronium

The Basics

What is Rocuronium?

Widely used to produce muscle relaxation to help facilitate surgery and ventilation of the lungs in elective and emergent situations.

Brand names for Rocuronium

Raplon

How Rocuronium is classified

Muscle Relaxants, Neuromuscular Nondepolarizing Agents

Rocuronium During Pregnancy

Rocuronium pregnancy category

Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Rocuronium while pregnant

Reproduction studies have been performed in pregnant nonventilated New Zealand White rabbits and nonventilated Sprague Dawley rats. Throughout gestation days 6-18, rabbits received 0.75, 1.5, or 3 mg/kg/day of rapacuronium bromide by continuous infusion. Rats, during gestation days 6-17, received intravenous doses of 0.75, 1.5, or 2.25 mg/kg/day of rapacuronium bromide in 3 divided doses at 30 minute intervals on each treatment day. No teratogenic effects were observed in rabbits or rats at the highest doses tested. The high doses of 3 and 2.25 mg/kg are approximately 0.3 and 0.1 times the maximum recommended human intravenous dose for adults on a mg/m2 basis, respectively. Post-implantation losses, as evidenced by increased resorption, were observed in rabbits at and above the lowest dose of 0.75 mg/kg, which is approximately 0.1 times the maximum recommended human intravenous dose for adults on a mg/m2 basis. Fetotoxicity, as evidenced by increased fetal deaths and subsequent resorption, was observed in rats at the high dose of 2.25 mg/kg. Which is approximately 0.1 times the maximum recommended human intravenous dose for adults on a mg/m2 basis. There are no adequate and well-controlled studies in pregnant women. During pregnancy there is passage of low levels of rapacuronium across the placenta and slow elimination following a single maternal dose (see CLINICAL PHARMACOLOGY, Clinical studies, Cesarean section). The risk to the developing fetus from extended low-dose instruterine exposure to a neuromuscular blocking agent is unknown. Because of these concerns and because animal reproduction studies are not always predictive of human response, this drug should not be used during pregnancy unless the potential benefit to the patient outweighs the potential risk to the fetus

Taking Rocuronium While Breastfeeding

What are recommendations for lactation if you're taking Rocuronium?

Limited information on the use of rocuronium during breastfeeding indicates that no adverse infant effects occur. Because it is short acting, highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant.[1][2] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using rocuronium as a component may delay the onset of lactation.

Maternal / infant drug levels

Limited information on the use of rocuronium during breastfeeding indicates that no adverse infant effects occur. Because it is short acting, highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant.[1][2] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using rocuronium as a component may delay the onset of lactation.

Possible effects of Rocuronium on milk supply

A randomized study compared the effects of cesarean section using general anesthesia, spinal anesthesia, or epidural anesthesia, to normal vaginal delivery on serum prolactin and oxytocin as well as time to initiation of lactation. General anesthesia was performed using propofol 2 mg/kg and rocuronium 0.6 mg/kg for induction, followed by sevoflurane and rocuronium 0.15 mg/kg as needed. After delivery, patients in all groups received an infusion of oxytocin 30 international units in 1 L of saline, and 0.2 mg of methylergonovine if they were not hypertensive. Fentanyl 1 to 1.5 mcg/kg was administered after delivery to the general anesthesia group. Patients in the general anesthesia group (n = 21) had higher post-procedure prolactin levels and a longer mean time to lactation initiation (25 hours) than in the other groups (10.8 to 11.8 hours). Postpartum oxytocin levels in the nonmedicated vaginal delivery group were higher than in the general and spinal anesthesia groups.[4]

Possible alternatives to Rocuronium

Atracurium, Cisatracurium.