Sugammadex Aspen

What Is Sugammadex Aspen and What Is It Used For?

Sugammadex Aspen contains the active substance sugammadex, a modified gamma-cyclodextrin that acts as a selective relaxant binding agent (SRBA). Unlike traditional reversal agents that work indirectly by inhibiting the enzyme acetylcholinesterase, sugammadex has a unique molecular mechanism: it directly encapsulates (wraps around) the neuromuscular blocking agents rocuronium bromide and vecuronium bromide, forming a tight, water-soluble, inactive complex inside the bloodstream. This complex is then excreted by the kidneys, effectively removing the muscle relaxant from the body within hours.

During many surgical procedures, general anaesthesia includes neuromuscular blocking agents (NMBAs) that cause complete skeletal muscle relaxation. This paralysis makes it easier for the surgeon to operate, particularly during abdominal, thoracic, cardiothoracic, and orthopaedic procedures, and it facilitates safe endotracheal intubation and mechanical ventilation. However, because these drugs also paralyse the respiratory muscles and diaphragm, patients require mechanical ventilation (artificial breathing support) throughout the operation and often into the immediate post-operative period until spontaneous respiration returns.

Sugammadex Aspen is used to accelerate the recovery of muscle function after surgery so that patients can resume spontaneous breathing, protective airway reflexes, and full muscle strength more quickly and reliably. By selectively binding to rocuronium or vecuronium molecules in the bloodstream, sugammadex rapidly reduces the free concentration of these blocking agents at the neuromuscular junction. This results in a much faster and more predictable reversal of paralysis compared to either the conventional approach of waiting for the drug to wear off naturally or using older reversal agents such as neostigmine combined with glycopyrrolate or atropine.

The drug is approved for use in adults when either rocuronium or vecuronium has been used as the neuromuscular blocking agent. For the paediatric population (children aged 2 to 17 years), sugammadex is recommended only for routine reversal of rocuronium-induced blockade. In some jurisdictions, use has been extended to neonates and infants under specialist supervision, though data in these youngest groups remain more limited. Sugammadex was first approved by the European Medicines Agency (EMA) in 2008 and subsequently by the U.S. Food and Drug Administration (FDA) in 2015. It has since become a standard component of modern perioperative care worldwide, with generic versions such as Sugammadex Aspen broadening access following patent expiry of the originator brand.

About the Generic: Sugammadex Aspen

Sugammadex Aspen is marketed as a generic medicinal product containing sugammadex sodium at a concentration of 100 mg/ml. As a generic, it has been approved on the basis of demonstrated pharmaceutical equivalence and bioequivalence with the reference product (the originator sugammadex). This means that Sugammadex Aspen contains the same active substance, at the same strength, in the same dosage form, and delivers the same amount of active drug to the systemic circulation within accepted statistical margins. Healthcare professionals can therefore expect the clinical performance of Sugammadex Aspen to be identical to that of the originator sugammadex in terms of speed of reversal, dose ranges, safety profile, and drug interaction potential.

For hospitals and health systems, the availability of generic sugammadex formulations has important practical implications: it broadens access to a clinically valuable reversal agent, reduces procurement costs, and supports wider adoption of evidence-based perioperative protocols that include quantitative neuromuscular monitoring and routine pharmacological reversal of all residual block.

Clinical Context in Anaesthesia Practice

Incomplete reversal of neuromuscular blockade — known as residual neuromuscular blockade or residual curarisation — is a well-documented risk of modern anaesthesia. Even minor residual blockade (a train-of-four ratio below 0.9 measured at the adductor pollicis muscle) is associated with an increased risk of upper airway obstruction, impaired hypoxic ventilatory drive, aspiration, atelectasis, and postoperative pulmonary complications. International surveys have suggested that residual blockade may affect 30–60% of patients in recovery rooms when neostigmine-based reversal is used without objective monitoring.

By providing rapid, reliable, and monitorable reversal across the spectrum of block depths — from shallow to profound and even immediate post-dose — sugammadex has meaningfully reduced the incidence of residual blockade in routine practice. Modern practice guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) and the American Society of Anesthesiologists (ASA) increasingly recommend routine use of quantitative neuromuscular monitoring and pharmacological reversal until a train-of-four ratio of at least 0.9 is confirmed. The widespread availability of generic formulations such as Sugammadex Aspen supports these clinical gains while helping health systems manage costs sustainably.

Why a Cyclodextrin?

Sugammadex is a modified gamma-cyclodextrin — a ring-shaped sugar-based molecule with a hydrophilic (water-loving) exterior and a lipophilic (fat-loving) interior cavity. The cavity is precisely sized and chemically tailored to accommodate the steroidal core of rocuronium and vecuronium. When sugammadex and rocuronium meet in the bloodstream, the rocuronium molecule slides into the cyclodextrin cavity, and the two form a very stable one-to-one inclusion complex. The encapsulated rocuronium is effectively sequestered away from the nicotinic acetylcholine receptors at the neuromuscular junction, so muscle function is restored. This targeted, chelation-like mechanism is fundamentally different from the competitive, acetylcholine-based mechanism of neostigmine and explains the superior speed and predictability of sugammadex reversal.

What Should You Know Before Receiving Sugammadex Aspen?

Because Sugammadex Aspen is a hospital-administered medicine given during anaesthesia, the anaesthesiologist will conduct a full pre-operative assessment before deciding whether it is suitable for you. Patients and caregivers should, however, ensure that specific medical conditions and medications are disclosed during the anaesthetic consultation, as these may influence dosing, monitoring, or the choice of reversal strategy. Providing an accurate list of prescription medicines, over-the-counter products, and herbal or dietary supplements is particularly important.

Contraindications

Sugammadex Aspen must not be given to anyone who has a known allergy (hypersensitivity) to sugammadex sodium or to any of the excipients in the formulation. If you have previously experienced an allergic reaction to sugammadex — even if it was considered mild — it is essential to inform your anaesthesiologist before any future surgical procedure. Re-exposure in a sensitised individual could trigger a more severe reaction, including anaphylaxis. Hypersensitivity reactions to sugammadex, ranging from isolated skin findings to full anaphylactic shock, have been documented in both clinical trials and post-marketing surveillance across multiple sugammadex products.

There are no other absolute contraindications; however, the drug is not recommended (a strong relative contraindication) in patients with severe renal impairment, including those requiring dialysis, as detailed below.

Warnings and Precautions

Before receiving Sugammadex Aspen, speak with your anaesthesiologist if any of the following conditions apply to you or to the patient in your care:

• Kidney disease: Sugammadex is excreted almost entirely through the kidneys as unchanged drug. Sugammadex Aspen is not recommended for patients with severe renal impairment (creatinine clearance below 30 ml/min), including those on dialysis. Patients with mild to moderate kidney problems may still receive it, but closer monitoring for delayed recovery is appropriate, and re-dosing intervals for rocuronium or vecuronium should be extended to 24 hours.
• Liver disease: Although sugammadex is not metabolised by the liver or excreted in bile, patients with severe hepatic impairment should be treated with particular caution. If liver disease is accompanied by coagulopathy, the bleeding-risk considerations below apply in addition. In most cases, no dose adjustment is required.
• Fluid retention (oedema) and cardiovascular disease: Conditions associated with prolonged circulation time, such as peripheral oedema, congestive heart failure, or advanced cardiovascular disease, may delay the time to full recovery after Sugammadex Aspen administration. The same dose can usually be given, but recovery times may be somewhat longer than in healthy subjects.
• Bleeding disorders or anticoagulant therapy: Sugammadex can cause a transient, limited prolongation of the activated partial thromboplastin time (aPTT) and prothrombin time (PT/INR). These effects are generally short-lived (under 30 minutes) and not clinically significant for most patients. However, an increased risk of bleeding cannot be excluded in patients with hereditary coagulation factor deficiencies, existing coagulopathies, those taking coumarin derivatives with an INR above 3.5, or those receiving the 16 mg/kg dose.
• Severe bradycardia and cardiac history: Isolated cases of marked bradycardia and cardiac arrest have been reported within minutes of administration. Patients should be closely monitored for haemodynamic changes during and after administration, and treatment with an anticholinergic (e.g. atropine) should be readily available in the operating theatre or recovery area.
• Morbid obesity: For patients with a body mass index (BMI) of 40 kg/m² or higher, doses are calculated using actual body weight, which may result in larger total doses but ensures reliable reversal.
• ICU settings: Use of sugammadex has not been specifically studied in intensive care unit (ICU) patients receiving rocuronium or vecuronium for prolonged paralysis. If sugammadex is considered in this context, close monitoring for recurrence of blockade is advised.

Pregnancy and Breastfeeding

There are no adequate data from the use of sugammadex in pregnant women. Animal studies have not shown direct or indirect harmful effects on pregnancy, embryo-foetal development, parturition, or postnatal development. Sugammadex Aspen should be used during pregnancy only when the clinical benefit justifies the potential risk, and the decision should be made in consultation with the treating anaesthesiologist and obstetric team. Where possible, elective procedures requiring neuromuscular blockade should be deferred until after pregnancy.

It is unknown whether sugammadex is excreted in human breast milk. Animal studies have shown excretion into breast milk, but oral absorption of cyclodextrins is generally very low, and no effect on a breastfed infant is expected after a single intravenous dose in the mother. A decision on breastfeeding should be made by the treating physician, weighing the benefit of breastfeeding for the child against the benefit of surgical treatment for the mother. Pumping and discarding milk for a short period after administration is not routinely required, but individual circumstances should be discussed, particularly for premature infants or those with underlying health conditions.

Effects on the Ability to Drive and Use Machines

Because Sugammadex Aspen is given in the context of general anaesthesia, driving and operating machinery are prohibited for at least 24 hours after the operation, or longer depending on the procedure and institutional discharge criteria. Sugammadex itself has no direct sedating effect, but the residual effects of anaesthetic agents (such as propofol, inhalational anaesthetics, and benzodiazepines) and opioid analgesics can impair cognitive and psychomotor performance well beyond the apparent subjective recovery of the patient.

Sodium Content

Sugammadex Aspen contains up to 9.7 mg of sodium per millilitre, corresponding to approximately 0.5% of the World Health Organization (WHO) recommended maximum daily dietary intake of 2 grams of sodium for adults. This is generally clinically insignificant for a single perioperative dose but should be considered for patients on a strict sodium-restricted diet or those receiving large cumulative volumes of sodium-containing intravenous therapy.

How Does Sugammadex Aspen Interact with Other Drugs?

Drug interactions with sugammadex can be categorised into two distinct mechanisms. The first involves displacement interactions, where other medications with higher binding affinity for sugammadex can displace the neuromuscular blocking agent from the sugammadex complex, potentially leading to recurrence of neuromuscular blockade. The second involves complex-forming (capturing) interactions, where sugammadex itself binds to other drugs, reducing their effectiveness. A third category involves in-vitro pharmacodynamic effects on coagulation parameters that are generally not clinically significant in routine practice.

Major Interactions

When certain medications are administered after Sugammadex Aspen, they could theoretically cause rocuronium or vecuronium to be displaced from the sugammadex molecule. If this occurs, the neuromuscular blocking effect may return, requiring ventilatory support and possible re-dosing of sugammadex or the use of an alternative non-steroidal neuromuscular blocker. Patients should therefore be monitored for signs of recurrence of blockade for up to 15 minutes if another drug is administered parenterally within 7.5 hours of sugammadex. In the post-operative setting, toremifene (an anti-oestrogen used in breast cancer) and intravenous fusidic acid (an antibiotic) are the most clinically relevant examples.

Minor and Pharmacodynamic Interactions

Sugammadex may bind to certain other drugs administered concurrently, thereby reducing their free plasma concentration and clinical effect. The most clinically relevant example is the interaction with hormonal contraceptives, particularly progestogens. Pharmacodynamic interactions with anticoagulants (heparins, vitamin K antagonists, direct oral anticoagulants) have been observed in in-vitro studies but are rarely clinically meaningful in routine postoperative thromboprophylaxis.

Effect on Hormonal Contraceptives

Sugammadex can reduce the effectiveness of hormonal contraceptives, including combined oral contraceptive pills, progestogen-only pills, vaginal rings, implants, and hormonal intrauterine devices. The interaction arises because sugammadex binds to progestogen in the circulation, reducing its free plasma concentration. Pharmacokinetic modelling suggests the effect is equivalent to one missed oral contraceptive pill, though the practical consequence depends on when in the contraceptive cycle the dose is given.

Re-Administration of Neuromuscular Blocking Agents

If neuromuscular blockade is required again after reversal with Sugammadex Aspen — for example, if the patient needs to return to theatre or if a further airway intervention is required — specific waiting times must be observed before re-administering rocuronium or vecuronium. These waiting times depend on the dose of sugammadex previously given and the intended dose of the neuromuscular blocking agent. If rapid re-paralysis is needed before the recommended waiting time has elapsed, a non-steroidal neuromuscular blocking agent such as cisatracurium should be used instead, since these are not affected by sugammadex.

What Is the Correct Dosage of Sugammadex Aspen?

Sugammadex Aspen should only be administered by, or under the direct supervision of, an anaesthesiologist. The use of objective neuromuscular monitoring — preferably quantitative train-of-four (TOF) monitoring at the adductor pollicis or another validated muscle — is strongly recommended to assess the depth of blockade and determine the appropriate timing and dose of reversal. All doses are calculated based on actual body weight, including in patients with obesity (BMI ≥ 40 kg/m²) and in paediatric patients.

Adults

Children (2 to 17 Years)

Sugammadex Aspen is approved for routine reversal of rocuronium-induced blockade in paediatric patients aged 2 to 17 years. The weight-based dosing is the same as for adults:

• 2 mg/kg at reappearance of T2 (routine reversal of moderate blockade)
• 4 mg/kg at 1–2 PTC (routine reversal of deep blockade)

For paediatric patients, Sugammadex Aspen 100 mg/ml may be diluted to 10 mg/ml with 0.9% sodium chloride to improve dosing accuracy, particularly in younger children where small volumes are critical. Dilution should be performed using aseptic technique, and the diluted solution should be used promptly.

Elderly Patients

Conditions associated with prolonged circulation time, including advanced age, may be associated with longer recovery times after sugammadex administration. While the dose recommendations are the same as for other adults, elderly patients may experience slightly slower reversal. No dose adjustment is required, but cardiovascular and respiratory monitoring should continue as for any patient emerging from anaesthesia, with particular attention to blood pressure and heart rate in patients with cardiovascular comorbidities.

Renal Impairment

Sugammadex is primarily excreted renally. Sugammadex Aspen is not recommended for patients with severe renal impairment (creatinine clearance below 30 ml/min) or those requiring dialysis. For patients with mild or moderate renal impairment, the standard dose can be used; however, the waiting time before re-administering rocuronium (0.6 mg/kg) or vecuronium (0.1 mg/kg) should be extended to 24 hours to allow for complete clearance. If sugammadex is inadvertently administered to a patient with severe renal impairment and removal is clinically necessary, haemodialysis with a high-flux filter can reduce plasma concentrations by up to 70% over 3–6 hours; low-flux filters are ineffective.

Patients with Obesity

For patients with obesity, including morbid obesity (BMI ≥ 40 kg/m²), the dose should be calculated using actual body weight rather than ideal or lean body weight. The same dosing recommendations as for other adults apply. Dedicated clinical studies in patients with morbid obesity have confirmed that this weight-based approach provides reliable and complete reversal, avoiding the risk of under-dosing that would occur if ideal body weight were used.

Hepatic Impairment

Because sugammadex is not metabolised by the liver and is eliminated essentially unchanged through the kidneys, no dose adjustment is required in patients with mild to moderate hepatic impairment. In severe liver disease, caution is advised, especially when there is concurrent coagulopathy. Specific clinical data in severe hepatic impairment are limited, and clinical judgement by the anaesthesiologist is required.

Missed Dose

Because Sugammadex Aspen is administered as a single intravenous bolus in the operating theatre or immediate post-anaesthesia area, there is no concept of a "missed dose" in the outpatient sense. The decision to administer, and the exact timing, are determined by the anaesthesiologist on the basis of intraoperative neuromuscular monitoring and clinical judgement. If reversal is believed to have been incomplete (for example, if signs of residual blockade appear in recovery, such as weakness, difficulty swallowing, or respiratory distress), an additional dose may be given by the anaesthetic team in accordance with local protocols.

Overdose

In clinical studies, one case of accidental overdose at 40 mg/kg was reported without significant adverse effects. In a human tolerability study, doses up to 96 mg/kg were administered without dose-related serious adverse effects. There is no specific antidote. Sugammadex can be removed by haemodialysis using a high-flux filter (up to 70% plasma concentration reduction after 3–6 hours), but not with a low-flux filter. In the event of a suspected overdose, supportive care and continued neuromuscular, cardiovascular, and respiratory monitoring are the mainstays of management until complete recovery.

What Are the Side Effects of Sugammadex Aspen?

Like all medicines, Sugammadex Aspen can cause side effects, although not everybody experiences them. Because Sugammadex Aspen is administered alongside other anaesthetic agents and neuromuscular blocking agents in the surgical setting, establishing a clear causal relationship for many adverse events is challenging. The safety profile of sugammadex has been evaluated in more than 3,500 subjects in pooled Phase I–III studies and has been extensively characterised through more than a decade of post-marketing surveillance worldwide. As a generic bioequivalent, Sugammadex Aspen is expected to share this safety profile without meaningful deviation.

Hypersensitivity: Detailed Information

In a dedicated randomised, double-blind study in healthy volunteers receiving up to three doses of sugammadex, the incidence of adjudicated hypersensitivity was 1.3% in the placebo group, 6.6% in the sugammadex 4 mg/kg group, and 9.5% in the sugammadex 16 mg/kg group. Verified anaphylaxis occurred in one subject at the 16 mg/kg dose (incidence 0.7%). In an earlier study of similar design, three verified cases of anaphylaxis were reported, all at 16 mg/kg (incidence 2.0%). There was no evidence of increased frequency or severity with repeated dosing. Post-marketing experience has identified hypersensitivity both to sugammadex alone and to the sugammadex-rocuronium complex. Importantly, reactions have occurred in patients with no prior exposure to sugammadex, so vigilance is required on every administration, not only first exposure.

Special Populations

Patients with pulmonary disease: Bronchospasm has been reported as a possibly related adverse reaction, and it appears more frequently in patients with a history of pulmonary complications or reactive airway disease (e.g. asthma or chronic obstructive pulmonary disease). Clinicians should be vigilant for this possibility and consider prophylactic bronchodilator therapy where clinically appropriate, particularly if the patient has had peri-operative airway symptoms.

Paediatric patients: In studies of children aged 2 to 17 years, the safety profile at doses up to 4 mg/kg was generally similar to that in adults, with no clinically meaningful differences in the frequency or nature of adverse reactions. Longer-term safety data in paediatric populations continue to accumulate.

Patients with morbid obesity: Dedicated clinical studies have confirmed that the safety profile in patients with BMI ≥ 40 kg/m² is generally similar to that of the overall adult population when dosing is based on actual body weight. Under-dosing (as can happen when ideal body weight is used) is a greater risk than over-dosing in this population.

ASA class 3–4 patients: In a study of patients with severe systemic disease, the adverse event profile was generally similar to the pooled adult data, although overall event rates were higher as expected in this higher-risk group.

Reporting of Side Effects

If you experience any side effects, discuss them with your surgical team, anaesthesiologist, or primary care provider. In many countries, patients and healthcare professionals can also report suspected adverse drug reactions directly to the national pharmacovigilance authority — for example the FDA MedWatch system in the United States, the MHRA Yellow Card Scheme in the United Kingdom, or the EMA EudraVigilance system in the European Union. Such reporting helps improve knowledge about the safety of Sugammadex Aspen and other generic sugammadex products, and contributes to the early detection of rare safety signals that may not have been visible in clinical trials.

How Should Sugammadex Aspen Be Stored?

Storage of Sugammadex Aspen is handled by healthcare professionals in the hospital pharmacy or operating theatre environment. Patients generally do not store this medicine themselves. The following general storage guidelines apply and should always be confirmed against the specific product packaging and the local prescribing information for the exact batch in use:

• Unopened vials: Store below 30°C. Do not freeze. Keep the vials in the outer carton to protect from light. Shelf life is as indicated on the label, typically 2–3 years from manufacture.
• After opening or dilution: Store at 2–8°C and use within 24 hours. Chemical and physical stability data indicate that sugammadex is stable for up to 48 hours at 2–25°C after dilution, but from a microbiological standpoint, the diluted product should be used immediately unless dilution was performed under controlled and validated aseptic conditions in a licensed pharmacy environment.
• Appearance: Sugammadex Aspen is a clear, colourless to slightly yellow or brownish-yellow solution. Do not use if the solution appears discoloured beyond these limits or contains visible particulate matter. Check each vial immediately before use.
• Do not use after the expiry date shown on the carton and vial label. The expiry date refers to the last day of that month.

Compatibility with Intravenous Fluids

Sugammadex Aspen can be injected into an intravenous line concurrently running with the following solutions: 0.9% sodium chloride, 5% glucose, 0.45% sodium chloride with 2.5% glucose, Ringer's lactate solution, or Ringer's solution. The intravenous line must be flushed thoroughly (e.g. with 0.9% sodium chloride) between the administration of Sugammadex Aspen and other drugs to avoid physical or chemical incompatibility. Known physical incompatibilities have been reported with verapamil, ondansetron, and ranitidine, among others — these agents must not be mixed in the same line or syringe at the time of sugammadex administration.

Disposal

Any unused medicine should be disposed of in accordance with local requirements and hospital pharmaceutical waste procedures. Do not dispose of medicines via wastewater or household waste. These measures help to protect the environment and reduce the risk of inappropriate use. Sharps waste (used ampoules, syringes, and needles) must be disposed of in approved sharps containers in line with hospital policy and national regulations.

What Does Sugammadex Aspen Contain?

Active Ingredient

The active substance is sugammadex, supplied as sugammadex sodium. Each 1 ml of solution for injection contains sugammadex sodium equivalent to 100 mg of sugammadex. Sugammadex Aspen is typically available in two vial sizes:

• 2 ml vial: 200 mg of sugammadex
• 5 ml vial: 500 mg of sugammadex

Inactive Ingredients (Excipients)

• Water for injections
• Hydrochloric acid 3.7% (for pH adjustment)
• Sodium hydroxide (for pH adjustment)

The formulation is preservative-free. Vials are intended for single use only; any unused portion should be discarded at the end of the procedure and not stored for re-use on a different patient.

Packaging

Sugammadex Aspen is supplied in packs containing 2 ml or 5 ml clear glass vials with rubber stoppers and aluminium seals. Pack sizes may vary by country; not all pack sizes may be marketed in all regions. For exact pack size, batch number, and manufacturer details applicable to a specific market, refer to the patient information leaflet supplied with the product or your hospital pharmacy records.

Marketing Authorisation and Manufacturer

Sugammadex Aspen is a generic medicinal product and is marketed under a separate marketing authorisation from the originator sugammadex. Full details of the marketing authorisation holder, manufacturer, and distribution in each country are provided on the product packaging and in the country-specific Summary of Product Characteristics (SmPC) or package insert. Pharmacists should verify that the product received corresponds to the labelled batch.

References

1. European Medicines Agency (EMA). Sugammadex — Summary of Product Characteristics (generic sugammadex products). Last updated 2025. Available at: www.ema.europa.eu/en/medicines
2. U.S. Food and Drug Administration (FDA). Sugammadex Prescribing Information. Reference approval NDA 022225. Available at: www.accessdata.fda.gov
3. Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database of Systematic Reviews. 2017;(8):CD012763. doi:10.1002/14651858.CD012763
4. Carron M, Zarantonello F, Lazzarotto N, Tellaroli P, Ori C. Role of sugammadex in accelerating postoperative discharge: A meta-analysis. Journal of Clinical Anesthesia. 2017;39:38–44.
5. Puhringer FK, Rex C, Sielenkamper AW, et al. Reversal of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor-blinded, phase II trial. Anesthesiology. 2008;109(2):188–197.
6. World Health Organization. WHO Model List of Essential Medicines — 23rd List (2023). Geneva: WHO; 2023. Available at: www.who.int
7. Fuchs-Buder T, Meistelman C, Raft J. Sugammadex: clinical development and practical use. Korean Journal of Anesthesiology. 2013;65(6):495–500.
8. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesthesia and Analgesia. 2007;104(3):575–581.
9. British National Formulary (BNF). Sugammadex monograph. London: Joint Formulary Committee; updated 2025. Available at: bnf.nice.org.uk
10. Herring WJ, Mukai Y, Wang A, et al. A randomized trial evaluating the safety profile of sugammadex in high surgical risk ASA physical class 3 or 4 participants. BMC Anesthesiology. 2021;21:259.
11. Fuchs-Buder T, Romero CS, Lewald H, et al. Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. European Journal of Anaesthesiology. 2023;40(2):82–94.

Editorial Team

Evidence standard: All medical claims in this article are supported by Level 1A evidence from systematic reviews, randomised controlled trials, and official regulatory documents (EMA SmPC, FDA prescribing information, BNF, WHO Essential Medicines List). This content is updated regularly to reflect the latest approved prescribing information for sugammadex-containing products.

Conflict of interest statement: iMedic receives no funding from pharmaceutical companies. All editorial content is independent and free from commercial influence. Generic and originator products are discussed neutrally on the basis of clinical evidence.