Sugammadex

Pronunciation: soo-GAM-a-decks.

Generic name: sugammadex
Brand names: Bridion, Sugammadex BNM, Brimadex, Sugammadex Sandoz, Sugammadex-Teva, Sugammadex Viatris
Drug class: Selective relaxant binding agent (modified gamma-cyclodextrin) -- neuromuscular blockade reversal agent
Form: Solution for injection (100 mg/mL, 200 mg/2 mL or 500 mg/5 mL vials)
Route: Intravenous, single bolus injection (over about 10 seconds into an existing IV line)
Legal status: Prescription-only, hospital/anaesthesia administration only

Supply Rules Vary

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: BRIDION (5), SUGAMMADEX SANDOZ / SUGAMMADEX-TEVA / SUGAMMADEX VIATRIS / SUGAMMADEX MSN / BGx SUGAMMADEX / SUGAMMADEX MEDSURGE / BRIMADEX (5) · Full directory

What sugammadex is and how it works

Sugammadex is a medicine used during and after surgery to reverse the effects of certain muscle-relaxant drugs (rocuronium or vecuronium) that were given to keep muscles still during anaesthesia. It works by binding tightly around the muscle relaxant, quickly removing its effect and allowing normal muscle movement and breathing to return. (1) (2) (4)

Sugammadex is given as a single injection into a vein by the anaesthesia team, either during surgery or afterwards, to help you wake up with your muscles working normally again. It is not a medicine you take yourself, and it is not available for home use or through a pharmacy.

Mechanism of action: how sugammadex works

Sugammadex is a modified gamma-cyclodextrin that forms a tight 1:1 complex with the steroidal neuromuscular blocking agents rocuronium and vecuronium, encapsulating them and rapidly reducing the amount available to act at the neuromuscular junction. It is not effective against nonsteroidal agents (e.g. suxamethonium) and has insufficient data to be recommended for pancuronium reversal. It is eliminated mainly unchanged via the kidneys and undergoes no hepatic metabolism. (1) (2) (4)

What sugammadex is used for

Reversal of rocuronium- or vecuronium-induced neuromuscular blockade

Sugammadex is used to reverse the muscle-relaxing effect of rocuronium or vecuronium after surgery, allowing the anaesthesia team to confirm that normal muscle strength and breathing have returned before the breathing tube is removed. (1) (2) (4) (6)

Immediate reversal (rocuronium only)

In situations where the anaesthesia team needs to reverse the muscle relaxant very quickly (for example, an unexpected difficult airway), a higher dose of sugammadex can be given for rapid reversal, but only after rocuronium -- not vecuronium. (2) (4)

Before taking sugammadex

Do not take / not appropriate for

Do not give sugammadex to someone with a known hypersensitivity to sugammadex or any of its ingredients. (all indications) (1) (2) (4)
Sugammadex should not be given to children younger than 2 years, per the New Zealand label; the UK/EU label permits routine rocuronium reversal from birth, and the US label describes broader pediatric use -- this is a genuine difference between country labels, not a single global rule. (pediatric) (4) (2) (1)
Sugammadex should not be used to reverse blockade from nonsteroidal neuromuscular blocking agents (e.g. suxamethonium/succinylcholine) or from pancuronium, since it is not effective or adequately studied for these. (all indications) (4)

Tell your clinician about

The anaesthesia team should know about any prior allergic reactions to medicines, since hypersensitivity/anaphylaxis reactions to sugammadex are possible and risk appears to increase with dose.
Tell the team about any heart conditions, since marked bradycardia (a very slow heart rate) has occurred within minutes of sugammadex administration, rarely progressing to cardiac arrest.
Tell the team about kidney problems, especially severe kidney impairment or dialysis, since sugammadex is not recommended in this situation.
Tell the team about liver problems, especially if accompanied by a bleeding/clotting disorder, since extra caution is needed.
Tell the team about all medicines being taken, especially hormonal contraceptives (the pill, patch, ring, or implant), toremifene, or IV fusidic acid, since these can interact with sugammadex.
Tell the team about any blood-thinning medicines (anticoagulants), since sugammadex can cause a temporary change in some clotting-time blood tests.
Tell the team if pregnant or breastfeeding.

(1) (2) (4)

How to take sugammadex

Sugammadex is given as a single injection into an existing intravenous line, over about 10 seconds, by a member of the anaesthesia team.
The dose is calculated by the anaesthetist based on actual body weight and how deep the muscle-relaxant effect is at the time (assessed using nerve-stimulation monitoring), not a fixed amount for everyone.
Ventilatory (breathing) support continues until normal spontaneous breathing and the ability to protect the airway are confirmed, even after sugammadex is given.
In children aged 2 years and older, the same medicine may be diluted to allow a more accurate dose for their smaller body weight.

(1) (2) (4)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (6) (5)

Missed dose

Not applicable. Sugammadex is a single, clinician-administered injection given at a specific point during or after surgery, not an ongoing dosing schedule.

Overdose

One accidental overdose of 40 mg/kg has been reported without significant effects. If an overdose is suspected, the clinical team will monitor closely; sugammadex can be removed from the blood by haemodialysis using a high-flux filter if needed. (1)

Side effects

Most reported effects relate to the surgery and anaesthesia itself rather than sugammadex specifically, but two effects need urgent attention: allergic-type reactions and a sudden slow heart rate.

Cough, airway-related effects of anaesthesia

What to notice: These are commonly reported around the time of waking from anaesthesia.

What to do: The clinical team monitors and manages these as part of routine anaesthesia recovery care. (2)

Nausea, vomiting, pain, headache

What to notice: These are among the most commonly reported effects in adults.

What to do: Tell the recovery-room nurse or doctor; these are usually treated with standard supportive care. (1)

Procedural hypotension

What to notice: A temporary drop in blood pressure around the time of the procedure.

What to do: The clinical team monitors blood pressure and treats this as needed. (2)

Signs of an allergic reaction

What to notice: Rash, hives, swelling, flushing, difficulty breathing, or a sudden drop in blood pressure.

What to do: This is a medical emergency. The clinical team is prepared to treat hypersensitivity and anaphylactic reactions immediately. (1) (2) (4)

Sudden slow heart rate (bradycardia)

What to notice: A marked drop in heart rate, which can occur within minutes of the injection and, in rare cases, has progressed to cardiac arrest.

What to do: The clinical team monitors heart rhythm closely after sugammadex and will give a medicine such as atropine if the heart rate drop is significant. (1) (2) (4)

Recurrence of muscle weakness (recurarisation)

What to notice: Muscle weakness or breathing difficulty returning after initially recovering.

What to do: The clinical team continues monitoring after the procedure and can give further treatment, including additional sugammadex or breathing support, if this occurs. (1) (2) (4)

Serious warnings

Hypersensitivity and anaphylaxis — emergency

Symptoms: Skin reactions (rash, hives, flushing) up to serious systemic reactions including anaphylactic shock; risk appears to increase with dose.

Action: The anaesthesia team must be prepared for this possibility before every dose, with resuscitation equipment and medicines available, and will treat any reaction immediately. (1) (2) (4)

Marked bradycardia and cardiac arrest — emergency

Symptoms: A significant, sometimes rapid drop in heart rate within minutes of the injection; rare cases have progressed to cardiac arrest.

Action: Close heart-rhythm and blood-pressure monitoring is required after every dose; the clinical team will give an anticholinergic medicine such as atropine if the bradycardia is clinically significant. (1) (2) (4)

Recurrence of neuromuscular blockade (recurarisation) — high

Symptoms: Return of muscle weakness or inadequate breathing after apparent recovery, seen in about 0.2% of monitored patients in clinical studies, more likely with lower-than-recommended doses.

Action: Postoperative monitoring is mandatory; the clinical team will provide breathing support and may re-administer sugammadex if this occurs. (1) (2) (4)

Reduced effectiveness of hormonal contraceptives — moderate

Symptoms: Not a physical symptom -- sugammadex can bind and reduce the effect of progestogen hormones, lowering contraceptive protection.

Action: A dose of sugammadex is considered equivalent to missing one dose of an oral contraceptive; an additional, non-hormonal method of contraception should be used for 7 days after sugammadex is given. (1) (2)

Interactions

Medicine or test	Effect	Action
Hormonal contraceptives (oral, patch, ring, implant)	Sugammadex binds progestogen, reducing contraceptive effectiveness -- equivalent to missing one oral contraceptive dose.	Use an additional, non-hormonal contraceptive method for 7 days after sugammadex administration. (1) (2)
Toremifene	May displace rocuronium or vecuronium from the sugammadex complex, potentially delaying full muscle recovery.	The anaesthesia team will monitor recovery more closely if toremifene has been used. (1) (2)
Intravenous fusidic acid	Pre-operative use may delay recovery of neuromuscular function.	The anaesthesia team will account for this if fusidic acid has recently been given. (2)
Anticoagulants (vitamin K antagonists, heparin, low molecular weight heparin, rivaroxaban, dabigatran)	Sugammadex can cause a temporary prolongation of clotting-time blood tests (aPTT, PT/INR); a clinically relevant increase in bleeding has not been consistently shown at standard doses.	The clinical team may monitor coagulation tests more closely, particularly at the higher 16 mg/kg dose or in patients with known clotting disorders. (2) (4)
Medicines that potentiate neuromuscular blockade, given after sugammadex	May increase the risk of recurrence of neuromuscular blockade (recurarisation).	The anaesthesia team pays special attention to this possibility postoperatively. (4)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

There is no clinical human data on sugammadex use in pregnancy. Animal studies have not shown direct harmful effects. The anaesthesia team will weigh the clinical need against the limited available data. (1) (2)

Breastfeeding

There is no human data on sugammadex in breast milk. Animal data show it passes into milk. The decision to continue breastfeeding balances the benefit against the need for the procedure, as judged by the clinical team. (1) (2)

Children

Country labels differ on the minimum age: the New Zealand label states sugammadex should not be given under 2 years old (with limited experience from 2 years and no data in neonates under 30 days), while the UK/EU label covers routine rocuronium reversal from birth to 17 years, and the US label describes broader pediatric use. Any pediatric use follows the applicable local label and specialist judgment. (4) (2) (1)

Elderly patients

The same dose recommendation is used as for younger adults, based on body weight, although recovery may take somewhat longer in older patients. (4)

Severe kidney or liver problems

Sugammadex is not recommended in severe kidney impairment, including patients on dialysis. Extra caution is used in severe liver impairment, especially with a bleeding/clotting disorder. (2) (4)

Monitoring

Before starting

Confirm the depth of neuromuscular blockade using an appropriate nerve-stimulation monitoring technique before selecting the sugammadex dose.
Review allergy history and medicines that may interact (hormonal contraceptives, toremifene, fusidic acid, anticoagulants).
Check kidney and liver function status, and confirm resuscitation equipment is available in case of a hypersensitivity reaction.

During treatment

Monitor heart rate and rhythm closely for several minutes after the injection, watching for marked bradycardia.
Watch for any signs of an allergic or anaphylactic reaction immediately after administration.
Continue ventilatory support until spontaneous breathing and airway protection are confirmed.
Monitor for recurrence of neuromuscular blockade (recurarisation) into the postoperative period.

(1) (2) (4)

Storage

Store below 25-30 degrees Celsius depending on the product; do not freeze. Protect from light; if exposed, use within 5-7 days depending on the specific product labelling. Refer to the specific product packaging for exact storage conditions.

Professional information

This is clinician-facing context only. Always refer to the current local product information and institutional protocols for dosing, administration, and safety guidance.

All regions

Indication: Reversal of rocuronium/vecuronium-induced neuromuscular blockade

Dose summary: Routine reversal: 4 mg/kg at 1-2 post-tetanic counts (median recovery to T4/T1 0.9 about 3 minutes), or 2 mg/kg at reappearance of T2 (median recovery about 2 minutes). Immediate reversal (rocuronium only): 16 mg/kg, given about 3 minutes after a 1.2 mg/kg rocuronium bolus (median recovery about 1.5 minutes); no data support immediate reversal after vecuronium. Pediatric routine reversal (2 years and older, per the NZ label; birth and older per UK/EU): 4 mg/kg at 1-2 PTC or 2 mg/kg at T2 reappearance; immediate-reversal dosing not established in children.

Renal context: No dose adjustment for mild-to-moderate renal impairment. Not recommended in severe renal impairment (CrCl <30 mL/min), including dialysis patients, due to insufficient safety data. (1) (2) (4)

Mechanism of action

Hepatic guidance

Dose recommendations are the same as for patients without hepatic impairment, since sugammadex is not metabolised or excreted by the liver; caution is advised in severe hepatic impairment, especially with an associated coagulopathy.

Overdose note

A single reported 40 mg/kg accidental overdose produced no significant effects. Sugammadex can be removed by haemodialysis using a high-flux filter (low-flux filters are ineffective). (1) (2) (4)

Frequently asked questions

Will I be awake when sugammadex is given?

It depends on the timing decided by the anaesthesia team -- sugammadex may be given while you are still under anaesthesia or as you are waking up, to reverse the muscle-relaxant effect before the breathing tube is removed.

Can sugammadex affect birth control?

Yes. Sugammadex can reduce the effectiveness of hormonal contraceptives (the pill, patch, ring, or implant) for a period afterward. It is treated as equivalent to missing one dose of an oral contraceptive, so an additional, non-hormonal method of contraception should be used for 7 days after receiving sugammadex. (1) (2)

Is sugammadex safe for children?

This depends on the country and age. The New Zealand label does not recommend sugammadex under 2 years old, while the UK/EU label allows routine use from birth for reversing rocuronium, and the US label describes broader pediatric use. Any use in children follows the anaesthesia team's judgment and the applicable local label. (4) (2) (1)

What is the most serious risk with sugammadex?

The two most serious risks are an allergic reaction (which can range from a mild skin reaction to a severe, life-threatening anaphylactic reaction) and a sudden slowing of the heart rate (marked bradycardia), which in rare cases has led to cardiac arrest. The anaesthesia team monitors closely for both after every dose. (1) (2) (4)

What is the mechanism of action of sugammadex?

What is the generic name of Sugammadex?

The generic name is sugammadex. It is sold under brand names including Bridion, Sugammadex BNM, Brimadex, Sugammadex Sandoz, Sugammadex-Teva, Sugammadex Viatris. (1) (2) (3) (4) (6) (5)

What class of drug is sugammadex?

Sugammadex is classed as: Selective relaxant binding agent (modified gamma-cyclodextrin) -- neuromuscular blockade reversal agent. (1) (2) (3) (4) (6) (5)

References

BRIDION (sugammadex) Injection, for intravenous use (Initial U.S. Approval: 2015)U.S. Food and Drug Administration (via DailyMed) · United States · accessed 2026-07-31 · source 1
Bridion 100 mg/ml solution for injection - Summary of Product Characteristics (SmPC)electronic Medicines Compendium (UK), Merck Sharp & Dohme · United Kingdom · accessed 2026-07-31 · source 2
Bridion (sugammadex) - European Public Assessment Report (EPAR), EMEA/H/C/000885European Medicines Agency · European Union · accessed 2026-07-31 · source 3
New Zealand Data Sheet - Sugammadex BNM 100 mg/mL solution for injectionMedsafe, New Zealand Medicines and Medical Devices Safety Authority · New Zealand · accessed 2026-07-31 · source 4
ARTG register - Bridion and multiple generic sugammadex productsTherapeutic Goods Administration · Australia · accessed 2026-07-31 · source 5
BRIDION - Health Canada Drug Product Database entry (DIN 02451816)Health Canada (Drug Product Database) · Canada · accessed 2026-07-31 · source 6

Brand names by country

Single-ingredient sugammadex names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

BRIDION100 mg/mL · medical purchasing solutions, llc

United Kingdom

BRIDION (2)current licensed product · 100 mg/mL · Merck Sharp & Dohme; see current EMC SmPC

Canada

BRIDION

Australia

BRIDION (5)current register product · 200 mg/2 mL, 500 mg/5 mL · Merck Sharp & Dohme (Australia) Pty Ltd -- ARTG 147716/148263, registered since 28 November 2008
SUGAMMADEX SANDOZ / SUGAMMADEX-TEVA / SUGAMMADEX VIATRIS / SUGAMMADEX MSN / BGx SUGAMMADEX / SUGAMMADEX MEDSURGE / BRIMADEX (5)current register products · 200 mg/2 mL or 500 mg/5 mL depending on product · Multiple generic sponsors -- see ARTG entries 359976, 375461, 377049, 421351, 407711, 367220, 392970

New Zealand

Sugammadex BNM (4)current regulator label · 100 mg/mL (200 mg/2 mL, 500 mg/5 mL vials) · BNM Group; see current Medsafe data sheet

View brands in additional countries.

European Union

BRIDION (3)