Sugammadex OK’d to reverse neuromuscular blockade during surgery



The Food and Drug Administration approved on Dec. 15 Merck’s sugammadex (Bridion) injection to reverse the effects of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide during surgery.

The safety and efficacy of sugammadex were evaluated in three phase III trials involving 456 participants; most recovered within 5 minutes. An FDA review of the drug found that there was less residual neuromuscular blockade with sugammadex compared to neostigmine, and a 4-minute time savings to extubation and operating room discharge.

“Bridion provides a new treatment option that may help patients recover sooner from medications used for intubation or ventilation during surgery. This drug enables medical personnel to reverse the effects of neuromuscular blocking drugs and restore spontaneous breathing after surgery,” Dr. Sharon Hertz, director of the FDA’s Division of Anesthesia, Analgesia, and Addiction Products, said in a statement.

Although approved in other countries, sugammadex has been in the FDA’s review process since 2007, previously rejected and held up by concerns over anaphylaxis and other issues.

Because of that, sugammadex was further evaluated in a randomized, double-blind, parallel-group, repeat-dose trial. Of the 299 participants treated with Bridion, one person had an anaphylactic reaction. “Clinicians should be aware of the possibility of a hypersensitivity reaction or anaphylaxis and should intervene as appropriate,” the agency said in its statement.

Cases of marked bradycardia, some of which have resulted in cardiac arrest, have also been observed within minutes after the administration of Bridion. Tachycardia and bradycardia have been associated with cases of anaphylaxis. “Patients should be closely monitored for hemodynamic changes during and after reversal of neuromuscular blockade, and treatment with anticholinergic agents, such as atropine, should be administered if clinically significant bradycardia is observed,” the agency said.

The most common side effects reported in trials were vomiting, hypotension, pain, headache, and nausea. “Doctors should also advise women using hormonal contraceptives that Bridion may temporarily reduce the contraceptive effect so they must use an alternate method of birth control for a period of time,” the agency said.

Rocuronium bromide and vecuronium bromide are used to paralyze the vocal cords for tracheal intubation, as well as to paralyze patients under general anesthesia and prevent spontaneous breathing during ventilation. Sugammadex is a new molecular entity of the gamma-cyclodextrin class, designed to bind rocuronium and vecuronium.

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