Page 172 - 2026 SMOG

ROCURONIUM (ZEMURON)
Class/Mechanism of Action
• Nondepolarizing Neuromuscular Blocking Agent (Paralytic)
Blocks acetylcholine from binding to motor neuron receptors, inhibiting depolarization.
˚ Onset of action—IV: 45sec to 3min (can be fast with higher doses and/or faster pushes);
Duration—IV: approximately 20–120min (increases with higher doses or hypothermia)
Indications
• Labeled Indications
˚ Rapid Sequence Intubation/paralysis and routine endotracheal intubation facilitate
mechanical ventilation in ICU patients.
Contraindications
• Hypersensitivity (e.g., anaphylaxis) to rocuronium, other neuromuscular-blocking agents, or
any component of the formulation
Adverse Reactions/Precautions
• Resistance may occur in burn patients (>30% of body) for a period of 5–70 days after injury.
• High potential for interactions: numerous drugs either antagonize (e.g., acetylcholinesterase
inhibitors) or potentiate (e.g., calcium channel blockers, certain antimicrobials, inhalation
anesthetics, lithium, magnesium salts, procainamide, and quinidine) the effects of
neuromuscular blockade; use with caution in patients receiving these agents
• Provides NO analgesia or sedation! Must provide appropriate sedation and analgesia
prior to paralytic use and throughout maintenance
• Pregnancy: Category C
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Rapid Sequence Intubation Rapid Sequence Intubation
• IV/IO • IV/IO
˚ 1mg/kg q30–45min ˚ 1mg/kg q30–45min
(Dosing ranges from 0.45–1.2mg/kg)
(Dosing ranges from 0.6–1.2mg/kg)
Note: In adult patients with morbid obesity
(BMI >50), use a dose of 1.2mg/kg using ideal
body weight (IBW).

164 • MEDICATIONS