Sugammadex: Mechanism of action and adverse side effects
A direct reversal agent with a high affinity for rocuronium and lesser affinity for vecuronium, capable of reversing even deep neuromuscular blockade.
Binds rocuronium and vecuronium (non-depolarizing neuromuscular blocking drugs (nNMBs)) in plasma when administered IV
↓ Concentration of functional nNMBs in plasma
Creates a concentration gradient from muscle tissue (high) to plasma (low)
nNMBs move from muscle compartment to plasma
Sugammadex in plasma encapsulates nNMBs that moved to the plasma
↓ Concentration of functional nNMBs in the plasma
↓ Concentration of nNMBs at the nicotinic acetylcholine receptor within the skeletal neuromuscular junction
Reverses neuromuscular blockade created by nNMBs
Progesterone is similar in structure to nNMBs
Sugammadex binds progesterone
↓ Progesterone activity in the body
Progesterone is critical for maintenance of early pregnancy
Unknown significance, avoid use in early pregnancy
Sugammadex-nNMB complex is cleared by the kidneys
Higher concentrations of sugammadex facilitate faster nNMB clearance
Unknown mechanisms
Post operative nausea and vomiting
Headache Bradycardia Cardiovascular Collapse
↓ Effectiveness of progesterone-based contraception for 7 days
↓ Clearance in patients with severe renal impairment
Reversal of profoundly deep neuromuscular blockade at higher doses
Binds to IgG or IgE receptors on sensitized basophils/mast cells in allergic reactions
Activation of basophils/mast cells
Degranulation of basophils/mast cells
Release of granulation products
Anaphylaxis Bronchospasm Hypotension
Authors: Arzina Jaffer, Kayleigh Yang Reviewers: Jasleen Brar, Mao Ding Joseph Ahn* * MD at time of publication
Movement of limbs or body during anesthesia
Coughing during anesthesia
Grimacing or suckling on the endotracheal tube
Sign/Symptom/Lab Finding
Published January 16, 2024 on