SUGAMMADEX KABI SOLUTION FOR INJECTION 100 MG/ML [SIN16988P]

Product Info

SUGAMMADEX KABI SOLUTION FOR INJECTION 100 MG/ML

[SIN16988P]

INDICATIONS:

Reversal of neuromuscular blockade induced by rocuronium or vecuronium in patients 2 years of age and older.

DOSAGE AND ADMINISTRATION:

Posology
Sugammadex should only be administered by, or under the supervision of an anaesthetist. 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 anaesthetic 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 – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

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 – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

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 – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

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 – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

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 and Warnings – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information) 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 section Precautions and Warning – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information.

Additional information on special population

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 and Warnings – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information)

Studies in patients with severe renal impairment do not provide sufficient safety information to support the use of sugammadex in these patients (see Pharmacology – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

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.

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 and Warnings – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Obese patients:
In obese patients, including morbidly obese patients (body mass index ≥ 40 kg/m²), the dose of sugammadex should be based on actual body weight. The same dose recommendations as for adults should be followed.

Hepatic impairment:
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 and Warnings – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

For mild to moderate hepatic impairment: as sugammadex is mainly excreted renally no dose adjustments are required.

Children and adolescents (2 years and older):
Sugammadex Kabi 100 mg/mL may be diluted to 10 mg/mL to increase the accuracy of dosing in the paediatric population. (see Method of Administration)

Routine reversal:
A dose of 4 mg/kg sugammadex is recommended for reversal of rocuronium or vecuronium induced blockade if recovery has reached at least 1–2 post-tetanic counts (PTC).

A dose of 2 mg/kg is recommended for reversal of rocuronium or vecuronium induced blockade at reappearance of T₂ (See Pharmacology – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).

Immediate reversal:
Immediate reversal in children and adolescents has not been investigated.

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.

Sugammadex has only been administered as a single bolus injection in clinical trials.

Sugammadex can be injected into the intravenous line of a running infusion with the following intravenous solutions: sodium chloride 9 mg/mL (0.9%), glucose 50 mg/mL (5%), sodium chloride 4.5 mg/mL (0.45%) and glucose 25 mg/mL (2.5%), Ringers lactate solution, Ringers solution, glucose 50 mg/mL (5%) in sodium chloride 9 mg/mL (0.9%).

The infusion line should be adequately flushed (e.g., with 0.9% sodium chloride) between administration of Sugammadex and other drugs.

Use in the paediatric population
For paediatric patients Sugammadex can be diluted using sodium chloride 9 mg/mL (0.9%) to a concentration of 10 mg/mL.

CONTRAINDICATIONS:

Hypersensitivity to the active substance or to any of the excipients. (See Composition – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information)