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Wednesday, November 30, 2016

SUGAMMADEX & DRUG INTERACTIONS


Sugammadex acts by forming a complex with steroidal Neuro Muscular Blocking Agents such as rocuronium and vecuronium and reduces their concentrations in the neuromuscular junction. 

Because of its inert structure, direct drug interactions are rarely expected with sugammadex. Two types of drug interactions may occur with sugammadex by displacement or capturing.

Drugs interacting with sugammadex by displacement : toremifene, fusidic acid, and flucloxacillin, could potentially affect the efficacy of sugammadex due to rocuronium 
or vecuronium being displaced from sugammadex.

Capturing interactions may occur if sugammadex binds with other drugs (i.e., hormonal contraceptives), and reduces their free plasma concentration. In addition, sugammadex might have decreased efficacy for rocuronium or vecuronium due to it binding with another 
drug.

Cyclodextrins have been reported to form inclusion complexes with other compounds.

In an in vitro experimental model of functionally innervated human muscle cells Rezonja et al. found that dexamethasone led to a dose-dependent inhibition of sugammadex reversal; but Ersel Gulec et al, who investigated the clinical relevance of the interaction between dexamethasone and sugammadex in humans failed to demonstrate any inhibitory effect of dexamethasone (0.5 mg/kg) on the reversal time of sugammadex in children.

N.B.(DO YOU KNOW?): It is clearly demonstrated that dexamethasone attenuates rocuronium-induced neuromuscular blockade when administered 2 to 3 hours before the induction of anesthesia; but not when dexamethasone is given at induction

Reference: The Effect of Intravenous Dexamethasone on Sugammadex Reversal Time in Children Undergoing Adenotonsillectomy; Ersel Gulec, Ebru Biricik, Mediha Turktan, Zehra Hatipoglu and Hakki Unlugenc, April 2016 • Volume 122 • Number 4, anesthesia-analgesia











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