Bridion Dosage/Direction for Use

Sugammadex should only be administered by, or under the supervision of an anesthetist. The use of an appropriate neuromuscular monitoring technique is recommended to monitor the recovery of neuromuscular blockade.
The recommended dose of sugammadex depends on the level of neuromuscular blockade to be reversed.
The recommended dose does not depend on the anesthetic regimen.
Sugammadex can be used to reverse different levels of rocuronium or vecuronium induced neuromuscular blockade: Adults: Routine reversal: A dose of 4 mg/kg sugammadex is recommended if recovery has reached at least 1-2 post-tetanic counts (PTC) following rocuronium or vecuronium induced blockade. Median time to recovery of the T₄/T₁ ratio to 0.9 is around 3 minutes (see Pharmacology: Pharmacodynamics under Actions).
A dose of 2 mg/kg sugammadex is recommended, if spontaneous recovery has occurred up to at least the reappearance of T₂ following rocuronium or vecuronium induced blockade. Median time to recovery of the T₄/T₁ ratio to 0.9 is around 2 minutes (see Pharmacology: Pharmacodynamics under Actions).
Using the recommended doses for routine reversal will result in a slightly faster median time to recovery of the T₄/T₁ ratio to 0.9 of rocuronium when compared to vecuronium induced neuromuscular blockade (see Pharmacology: Pharmacodynamics under Actions).
Immediate reversal of rocuronium-induced blockade: If there is a clinical need for immediate reversal following administration of rocuronium a dose of 16 mg/kg sugammadex is recommended. When 16 mg/kg sugammadex is administered 3 minutes after a bolus dose of 1.2 mg/kg rocuronium bromide, a median time to recovery of the T₄/T₁ ratio to 0.9 of approximately 1.5 minutes can be expected (see Pharmacology: Pharmacodynamics under Actions).
There is no data to recommend the use of sugammadex for immediate reversal following vecuronium induced blockade.
Re-administration of sugammadex: In the exceptional situation of recurrence of neuromuscular blockade post-operatively (see Precautions) after an initial dose of 2 mg/kg or 4 mg/kg sugammadex, a repeat dose of 4 mg/kg sugammadex is recommended. Following a second dose of sugammadex, the patient should be closely monitored to ascertain sustained return of neuromuscular function.
Re-administration of rocuronium or vecuronium after sugammadex: For waiting times for re-administration of rocuronium or vecuronium after reversal with sugammadex, see Precautions.
Additional information on special population: Renal impairment: For mild and moderate renal impairment (creatinine clearance ≥30 and <80 ml/min): the dose recommendations are the same as for adults without renal impairment.
The use of sugammadex in patients with severe renal impairment (including patients requiring dialysis (CrCl <30 ml/min)) is not recommended (see Precautions).
Studies in patients with severe renal impairment do not provide sufficient safety information to support the use of sugammadex in these patients. See also Pharmacology: Pharmacodynamics under Actions.
Elderly patients: After administration of sugammadex at reappearance of T₂ following a rocuronium induced blockade, the median time to recovery of the T₄/T₁ ratio to 0.9 in adults (18-64 years) was 2.2 minutes, in elderly adults (65-74 years) it was 2.6 minutes and in very elderly adults (75 years or more) it was 3.6 minutes. Even though the recovery times in elderly tend to be slower, the same dose recommendation as for adults should be followed (see Precautions).
Obese patients: In obese patients, including morbidly obese patients, the dose of sugammadex should be based on actual body weight. The same dose recommendations as for adults should be followed.
Hepatic impairment: For mild to moderate hepatic impairment: as sugammadex is mainly excreted renally no dose adjustments are required.
Studies in patients with hepatic impairment have not been conducted. Caution should be exercised when considering the use of sugammadex in patients with severe hepatic impairment or when hepatic impairment is accompanied by coagulopathy (see Precautions).
Pediatric population: The data for the pediatric population are limited (one study only for reversal of rocuronium induced blockade at reappearance of T₂).
Children and adolescents: For routine reversal of rocuronium induced blockade at reappearance of T₂ in children and adolescents (2-17 years) 2 mg/kg sugammadex is recommended. Other routine reversal situations have not been investigated and are therefore not recommended until further data become available.
Immediate reversal in children and adolescents has not been investigated and is therefore not recommended until further data become available.
Bridion 100 mg/ml may be diluted to 10 mg/ml to increase the accuracy of dosing in the pediatric population (see Special precautions for disposal and other handling under Cautions for Usage).
Term newborn infants and infants: There is only limited experience with the use of sugammadex in infants (30 days to 2 years), and term newborn infants (less than 30 days) have not been studied. The use of sugammadex in term newborn infants and infants is therefore not recommended until further data become available.
Method of administration: Sugammadex should be administered intravenously as a single bolus injection. The bolus injection should be given rapidly, within 10 seconds, into an existing intravenous line (see Special precautions for disposal and other handling under Cautions for Usage). Sugammadex has only been administered as a single bolus injection in clinical trials.