Rapacuronium Bromide

A to Z Drug Facts

 Action Binds competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.

 Indications Adjunct to general anesthesia to facilitate tracheal intubation; provide skeletal muscle relaxation during surgery.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: IV Initial dose: 1.5 mg/kg; maintenance dose: Up to three doses of 0.5 mg/kg. CESAREAN SECTION: 2.5 mg/kg with thiopental induction. CHILDREN 1 MO TO 12 YR: IV 2 mg/kg. CHILDREN 13 TO 17 YR: IV Determine dose by physical maturity, height, and weight using above dosing recommendations.

 Interactions

Antibiotics (eg, aminoglycosides, bacitracin, colistin, polymyxin, tetracyclines, vancomycin), inhalational anesthetics, lithium, local anesthetics, magnesium salts, procainamide, quinidine: Prolonged neuromuscular blockade may occur. Anticonvulsants (eg, carbamazepine, phenytoin): Shortened duration of action and decreased effectiveness. Incompatibilities: Cefuroxime, danaparoid, diazepam, nitroglycerin, thiopental.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV Hypotension; tachycardia; bradycardia; extrasystoles; arrhythmias; cardiac failure; MI. RESP: Bronchospasm. GI: Vomiting; nausea. DERM: Erythematous rash.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children < 1 mo: Safety and efficacy not established; has not been studied in patients 13 to 17 yr. Hepatic insufficiency: Use with caution, resistance to neuromuscular blockade and prolonged duration of blockade may occur. Obesity: Base initial dose in obese patients (body mass index ³ 30) on actual body weight; consider dosing morbidly obese patients (body mass index ³40) on ideal body weight. Renal failure: Onset time may be slowed and duration of blockade may be prolonged.

 Administration/Storage

• Store at 2° to 25°C (36° to 77°F).
• When reconstituted with sterile water, keep vial at room temperature or refrigerate at 2° to 25°C (36° to 77°F) and use within 24 hrs. For single use only, discard unused portion. Do not use if particulate matter is present.
• When reconstituted with bacteriostatic water, store at room temperature or refrigerate at 2° to 25°C (36° to 77°F) and use within 24 hrs.
• Do not administer to newborn infants if reconstituted with bacteriostatic water as it contains benzyl alcohol.
• Administer IV only in carefully adjusted doses individualized to patient needs by or under the supervision of experienced clinicians who are familiar with the drug actions and possible complications.
• Do not administer unless personnel and facilities for resuscitation and life support (tracheal intubation, artificial ventilation, oxygen therapy) and an antagonist (anticholinesterase [eg, neostigmine]) of the drug are available, and a peripheral nerve simulator to measure neuromuscular function are immediately available.
• Administration must be accompanied by adequate anesthesia or sedating agents.

 Assessment/Interventions

• Obtain patient history including drug history and any known allergies.
• Monitor the patient, including drug history and any known allergies.
• Monitor vital signs and keep airway clear of secretions.
• Use nerve stimulator to assess neuromuscular blockade.
• Continually monitor patient's hemodynamic status including bradycardia, tachycardia, hypotension, and hypertension.
• Monitor for ECG abnormalities and tachyphylaxis following repeated and large single doses.
• Ensure that a peripheral nerve simulator is available and used to monitor patient's responses to drug and recovery from neuromuscular block.
• Monitor for possible occurrence (rare) of malignant hyperthermia.
• Maintain patent airway, adequate oxygenation, and controlled ventilation in the case the neuromuscular block and subsequent respiratory depression extends beyond the time needed for surgery and anesthesia.
• Closely monitor patients with hepatic, respiratory, cardiac, muscular, and renal disease.
• Monitor patients with myasthenia gravis or Eaton-Lambert syndrome for potential profound and prolonged effects.

 Patient/Family Education

• Explain that drug will be administered while patient is unconscious.
• Inform family of the usual length and nature of the unit's routine as they are often in the waiting room.
• Inform family of patient's condition during the procedure and in the recovery room.
• Inform patient and family that hoarseness and sore throat may be experienced.
• Report any residual muscle weakness to primary caregiver.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts