Although very rare, cases of allergic reactions to sugammadex have been reported. Most of these cases have been reported from Asia, where sugammedex is most widely used.23 Anaphylaxis occurs in about 29 out of every 1 million patients.61 Risk of hypersensitivity reactions resulted in the initial delay of FDA approval of sugammadex.26,62 Since FDA approval and the subsequent increased use of sugammadex, the incidence of hypersensitivity is anticipated to rise.23
The mechanism of sugammadex anaphylaxis is not well understood. In contrast to NMBA anaphylaxis which largely believed to be IgE-mediated, the role of IgE is unknown in sugammadex anaphylaxis. Sugammadex specific IgE antibodies have not been found. One theory is that the complex formed …show more content…
Drugs with a higher affinity to sugammadex than rocuronium and vecuronium can potentially displace sugammadex from NMB-sugammadex complex with NMB reccurence.7 Toremifene, flucloxacillin and fusidic acid have been identified as potentially displacing NMB from sugammadex complex. Of the three drugs, reversal from NMB can be delayed if patients receive toremifene on the day of surgery.7
According to sugammadex’s drug information label, progestogens may bind sugammadex leading to possible contraceptive failure and lowered sugammadex efficacy upon NMB reversal.9,13 If an oral contraceptive containing estrogen or progestogen is taken prior to the day of surgery, it is recommended that a backup non-hormonal contraceptive for the next seven days should be used for the next seven days.13,14 However, in the first study examining the association between sugammadex and steroidal hormones found that sugammadex 4 mg/kg had no diminishing effects on progesterone or cortisol levels in patients.9
Prophylactic dexamethasone administration did not significantly diminish sugammadex reversal of NMB in patients undergoing general anesthesia, contradicting results of preclinical studies.65
H.
The mechanism of sugammadex anaphylaxis is not well understood. In contrast to NMBA anaphylaxis which largely believed to be IgE-mediated, the role of IgE is unknown in sugammadex anaphylaxis. Sugammadex specific IgE antibodies have not been found. One theory is that the complex formed …show more content…
Drugs with a higher affinity to sugammadex than rocuronium and vecuronium can potentially displace sugammadex from NMB-sugammadex complex with NMB reccurence.7 Toremifene, flucloxacillin and fusidic acid have been identified as potentially displacing NMB from sugammadex complex. Of the three drugs, reversal from NMB can be delayed if patients receive toremifene on the day of surgery.7
According to sugammadex’s drug information label, progestogens may bind sugammadex leading to possible contraceptive failure and lowered sugammadex efficacy upon NMB reversal.9,13 If an oral contraceptive containing estrogen or progestogen is taken prior to the day of surgery, it is recommended that a backup non-hormonal contraceptive for the next seven days should be used for the next seven days.13,14 However, in the first study examining the association between sugammadex and steroidal hormones found that sugammadex 4 mg/kg had no diminishing effects on progesterone or cortisol levels in patients.9
Prophylactic dexamethasone administration did not significantly diminish sugammadex reversal of NMB in patients undergoing general anesthesia, contradicting results of preclinical studies.65
H.