TM Owner Organon
Zemuron 10mg/mL Injection
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Indications & Clinical Uses
- Drugs.com lists the Zemuron brand as discontinued in the US; this appears to be a manufacturer discontinuation rather than a confirmed FDA withdrawal of approval, and generic rocuronium bromide injection remains available.
- The information below comes from the last FDA-posted Zemuron label (Organon, 2018).
- Zemuron 10mg/mL contains rocuronium bromide, a nondepolarizing neuromuscular blocking agent (muscle relaxant).
- It is used as an adjunct to general anaesthesia to help tracheal intubation, including rapid sequence intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
- It is supplied as 10 mg/mL in 5 mL multiple-dose vials and is given only by intravenous injection by experienced clinicians, or trained staff supervised by them.
- It has no effect on consciousness or pain, so it is always used with adequate anaesthesia or sedation.
Side Effects
- The most common effects in clinical studies (about 2% of patients) were transient low or high blood pressure.
- Less common effects (under 1%) included irregular or fast heartbeat, abnormal ECG, nausea, vomiting, wheezing or bronchospasm, hiccup, rash, swelling and itching.
- Serious risks include severe allergic reactions (anaphylaxis) that can be life-threatening or fatal and can cross-react with other muscle relaxants, residual paralysis after surgery (more likely in people aged 65 and over), reports of malignant hyperthermia, muscle weakness (myopathy) after prolonged use in intensive care, especially with corticosteroids, and QT interval prolongation in children given general anaesthetics.
- There is no boxed warning.
- The anaesthesia team monitors you throughout; tell them about any past allergic reaction to a muscle relaxant.
Precautions & Warnings
- Zemuron is contraindicated in people with hypersensitivity, such as anaphylaxis, to rocuronium or other neuromuscular blocking agents.
- Because it causes paralysis, giving it to the wrong patient can lead to respiratory arrest and death, so vials must be stored with the cap intact and checked before use.
- Breathing must be supported until muscle strength returns; reversal agents may be used, and nerve stimulator monitoring guides dosing.
- Use caution in significant liver impairment (duration is about 1.5 times longer).
- It is not recommended for rapid sequence intubation in children or in caesarean section patients.
- It has not been studied in people susceptible to malignant hyperthermia.
- In pregnancy, use only if the benefit justifies the risk.
- Store vials refrigerated at 2°C to 8°C, do not freeze; use within 60 days at room temperature and opened vials within 30 days.
Avoid Interactions
- Increase effect or duration of block: inhaled anaesthetics (enflurane more than isoflurane and halothane), antibiotics (aminoglycosides, vancomycin, tetracyclines, bacitracin, polymyxins, colistin), quinidine, procainamide, magnesium salts, lithium, local anaesthetics, propofol, succinylcholine and other neuromuscular blocking agents.
- Reduce effect: the anticonvulsants carbamazepine and phenytoin (long-term use) may lessen the block.
- Pharmacy point: Zemuron is incompatible with alkaline solutions, so it must not be mixed with them.
- Tell the anaesthesia team about all prescription and over-the-counter medicines, supplements and allergies before surgery, including any long-term anticonvulsant treatment, so that doses can be adjusted safely.
References
Frequently Asked Questions
Zemuron (rocuronium bromide) is a muscle relaxant given during general anaesthesia. It helps the anaesthetist place a breathing tube, including for rapid sequence intubation, and keeps muscles relaxed during surgery or mechanical ventilation. It does not cause sleep or block pain, so anaesthetic medicines are always given too.
Zemuron (rocuronium bromide) is given only as an intravenous injection by experienced clinicians or trained staff they supervise. A typical starting dose for intubation is 0.6 mg/kg, and later doses are guided by a nerve stimulator that measures muscle response. You will not give it to yourself.
Zemuron (rocuronium bromide) most often causes short-lived changes in blood pressure. Rarely, it can cause severe allergic reactions, residual muscle weakness after surgery, or prolonged weakness after long ICU use. The anaesthesia team monitors your breathing and reactions. It has no boxed warning.
Tell your anaesthesia team about past allergic reactions to muscle relaxants and about all your medicines. Zemuron (rocuronium bromide) is boosted by inhaled anaesthetics, some antibiotics, magnesium, lithium and quinidine, and weakened by carbamazepine or phenytoin. Your dose is adjusted accordingly.
After surgery, Zemuron (rocuronium bromide) wears off as muscle strength returns, and the team checks that you can breathe on your own before removing the breathing tube. A reversal agent may be used. Residual weakness is more likely in adults aged 65 and over.
Drugs.com lists the Zemuron brand as discontinued in the US, and generic rocuronium bromide remains available. Only the brand appears to have been discontinued; it is not confirmed as an FDA withdrawal of approval. Your hospital will supply whichever rocuronium product it stocks.
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