Last reviewed 2026-04-20 · How we verify

Rocuronium (Rocuronium Bromide)

Rocuronium bromide competes for cholinergic receptors at the motor end-plate, antagonized by acetylcholinesterase inhibitors.

Rocuronium bromide is a nondepolarizing neuromuscular blocking agent indicated as an adjunct to general anesthesia for rapid sequence and routine tracheal intubation and skeletal muscle relaxation. It competitively blocks cholinergic receptors at the motor end-plate with rapid to intermediate onset and intermediate duration, reversible by acetylcholinesterase inhibitors. Primary risks include hypersensitivity reactions, prolonged blockade with certain antibiotics and anesthetics, and resistance development with chronic anticonvulsant use. Careful monitoring of neuromuscular function and dose adjustment based on patient factors and concurrent medications is essential for safe use.

At a glance

Mechanism of action

Rocuronium bromide is a nondepolarizing neuromuscular blocking agent that acts by competing for cholinergic receptors at the motor end-plate. This competitive mechanism blocks acetylcholine from binding to these receptors, preventing normal neuromuscular transmission. The action is reversible and can be antagonized by acetylcholinesterase inhibitors such as neostigmine and edrophonium, which increase acetylcholine levels to overcome the blockade.

Approved indications

• Rapid sequence and routine tracheal intubation
• Skeletal muscle relaxation during surgery or mechanical ventilation

Common side effects

• transient hypotension
• hypertension
• tachycardia

Drug interactions

• Inhalation anesthetics (enflurane, isoflurane, halothane)
• Certain antibiotics (aminoglycosides, vancomycin, tetracyclines, bacitracin, polymyxins, colistin, sodium colistimethate)
• Anticonvulsants (carbamazepine, phenytoin)
• Magnesium
• Lithium
• Local anesthetics
• Quinidine
• Procainamide
• Nondepolarizing muscle relaxants
• Succinylcholine

Key clinical trials

• The Relationship Between Opioid-Free Anesthesia and Postoperative Agitation-Delirium and Quality of Recovery in Pediatric Ear, Nose, and Throat Cases Monitored With Perioperative Bispectral Index
• Impact of Sugammadex Versus Neostigmine on Early Postoperative Pulmonary Function (NA)
• Association of Sarcopenia With Rocuronium Use in Liver Transplant Recipients (NA)
• Awareness Neuraxial Versus General Anesthesia in Frail Patients Undergoing Laparoscopic or Robotic Abdominopelvic Surgery. (NA)
• Deep Versus Moderate Neuromuscular Blocking (NA)
• Effect of Neuromuscular Block Depth on Driving Pressure and Postoperative Respiratory Events in Abdominal Surgeries (NA)
• Safety and Efficacy of HRS-9190 Compared to Rocuronium for Bolus Maintenance in Adults (PHASE2)
• A Dose-response Study to Determine the Right Dosage of Sugammadex as a Reversal Agent of Rocuronium in Infants Between 1 and 24 Months Old (PHASE4)

Patents

Primary sources

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