Rocuronium bromide is available as a 10-mg/mL solution for injection in 5- and 10-mL multiple-dose vials.3373 Each mL of solution contains rocuronium bromide 10 mg with sodium acetate 2 mg, sodium chloride for isotonicity, and acetic acid and/or sodium hydroxide to adjust the pH.3373
pH
Adjusted during manufacture to pH 4.3373
Osmolality
The solution is isotonic.3373
Trade Name(s)
Zemuron
Rocuronium bromide is administered intravenously only by rapid intravenous injection or by intravenous infusion following dilution in an appropriate intravenous infusion solution.3373 Infusion rates should be individualized for each patient according to the requirements and response.3373
The infusion line should be adequately flushed with a compatible solution between administration of rocuronium bromide and other drugs for which compatibility has not been established.3373
Intact vials of rocuronium bromide should be stored under refrigeration at 2 to 8°C and protected from freezing.3373 Intact vials stored at room temperature should be used within 60 days.3373 Opened vials should be used within 30 days.3373
Solutions diluted for infusion should be used within 24 hours of mixing.3373 Unused portions of infusion solutions should be discarded.3373
pH Effects
Rocuronium bromide should not be mixed or administered simultaneously through the same line with alkaline solutions (e.g., barbiturate solutions).3373
Syringes
In 2015, reports of decreased potency of certain drugs (e.g., rocuronium bromide) stored in Becton Dickinson syringes for extended periods (i.e., exceeding 24 hours) were confirmed by the manufacturer of these syringes; the cause of this change was later identified to be the inclusion of an alternate rubber stopper in the plunger of certain product lots of syringes.3029; 3036; 3037; 3039; 3041; 3042 Decreased potency was not observed when the syringes were filled and used promptly.3037 Use of the alternate stopper was later discontinued and use of the primary stopper in such syringes was resumed; however, Becton Dickinson states that its general-use syringes are cleared by FDA for immediate use in fluid aspiration and injection and that such syringes, regardless of the stopper material, have not been cleared by FDA for use as a closed-container system.3391
Standardize 4 Safety
One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.
Table 1. Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Rocuronium3635; 3636
| Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
| Adultsa | 10 mg/mL | mcg/kg/minute (note dosing units differ from concentration units) |
| Pediatric patients (50 kg) | 10 mg/mL | mg/kg/hour |
aParalytics are recommended to be administered as straight drug. This provides consistency between operating room and the ICU, and eliminates potential compounding errors.
For a list of references cited in the text of this monograph, search the monograph titled References.