Rocuronium Bromide

Rocuronium bromide

Non-depolarizing Neuromuscular BlockerIVDogsCatsHorses

Also known as: Zemuron · Esmeron · ORG-9426 · rocuronii · rocuronio · rokuroniowy · rokuronyum · Rocuronium bromide

Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference

0.05-0.1 mg/kg i.v.IV· Single dose or prn· As needed

Body weight— 🐕

Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.

Dosing by species

🌎 NA — North America🌍 EU — Europe

Dogs

Indication	Dose	Route	Frequency	Duration	Region
As a neuromuscular blocker	0.5 mg/kg bolus and then a CRI was started immediately at 0.2 mg/kg/hour	IV	Bolus followed by CRI	—	🌎 NA
Neuromuscular blockade during anaesthesia	0.4 mg/kg i.v. followed, when required, by a maintenance dose of 0.16 mg/kg i.v. prn or continuous rate infusion of 0.2 mg/kg/h	IV	prn or CRI	As needed during surgery	🌍 EU
Centralize the globe for ophthalmic surgery	0.05-0.1 mg/kg i.v.	IV	Single dose or prn	As needed	🌍 EU

As a neuromuscular blocker: Authors concluded it was effective and easily applicable, but further work is required on infusion titration.
Neuromuscular blockade during anaesthesia: Monitoring with a nerve stimulator is recommended.
Centralize the globe for ophthalmic surgery: Considerably lower doses are required for this indication.

Cats

Indication	Dose	Route	Frequency	Duration	Region
As a neuromuscular blocker	0.6 mg/kg IV	IV	Single dose	—	🌎 NA
Neuromuscular blockade / Endotracheal intubation	0.3-0.6 mg/kg i.v.	IV	Single dose	Approx 20 min at 0.6 mg/kg	🌍 EU

As a neuromuscular blocker: Rapid onset, short duration of action, and does not cause significant changes in heart rate.
Neuromuscular blockade / Endotracheal intubation: 0.6 mg/kg has a rapid onset and short duration of action (20 min). Requires prompt successful intubation and ventilation.

Horses

Indication	Dose	Route	Frequency	Duration	Region
As a neuromuscular blocker	0.6 mg/kg IV	IV	Single dose	—	🌎 NA

As a neuromuscular blocker: Provided predictable blockade without hemodynamic changes, but large variation between individuals; monitoring of neuromuscular block is essential.

Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.

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Overview

Rocuronium bromide is an aminosteroidal, competitive, non-depolarizing neuromuscular blocking agent (NMBA). It is utilized primarily as an adjunct to general anesthesia to facilitate rapid endotracheal intubation and provide profound skeletal muscle relaxation during delicate surgical procedures (e.g., ophthalmic, neurologic, or thoracic surgeries).

Key pharmacological characteristics include:

Rapid to intermediate onset: Faster onset of action compared to vecuronium or atracurium (2-3 times faster than vecuronium), making it nearly as rapid as succinylcholine but with fewer adverse effects.
Intermediate duration of action: Similar duration to vecuronium and atracurium.
Cardiovascular stability: Exhibits minimal cardiovascular and histamine-releasing effects compared to older NMBAs.

Clinical Pearl: Neuromuscular blocking agents like rocuronium possess absolutely no analgesic, sedative, or amnestic properties. Administration to a conscious or inadequately anesthetized patient will result in the terrifying experience of complete paralysis while fully awake and able to feel pain. It must only be used in patients who are deeply anesthetized and where mechanical ventilation is immediately available.

Mechanism of action

Rocuronium acts by competitively antagonizing acetylcholine (ACh) at the neuromuscular junction.

Mechanism: It binds to nicotinic cholinergic receptors at the motor end plate of skeletal muscle.
Pathway: Rocuronium occupies the receptor site → prevents ACh from binding → inhibits depolarization of the muscle cell membrane → results in flaccid paralysis.
Reversal: Because the blockade is competitive, it can be antagonized by increasing the concentration of ACh in the synaptic cleft. This is achieved using acetylcholinesterase inhibitors (e.g., neostigmine, edrophonium). Alternatively, rocuronium can be directly encapsulated and inactivated in the plasma by the selective relaxant binding agent sugammadex.

Safety & warnings

Contraindications

Hypersensitivity to rocuronium or other neuromuscular blocking agents
Patients who are not adequately anesthetized or sedated
Settings lacking immediate access to intubation, mechanical ventilation, and oxygen therapy
Conscious or inadequately anaesthetized animals
Lack of positive pressure ventilation facilities

Adverse effects

Changes in heart rate (mild, transient tachycardia)
Changes in blood pressure (hypotension or hypertension)
Severe anaphylaxis (reported in humans)
Histaminoid reactions (rare)
Severe burning pain at the injection site (if administered before deep anesthesia is achieved)
Increased heart rate
Mild hypertension (at high doses)

Precautions

Rocuronium must only be used by trained personnel in settings where the patient can be fully monitored and where endotracheal intubation, mechanical ventilation, oxygen therapy, and reversal agents are immediately available.

It should only be administered to patients that are adequately anesthetized or sedated. Because the drug can cause severe burning pain upon injection, it is recommended to administer it only after a deep stage of anesthesia has been achieved. Use with caution in patients with hepatic or renal impairment, as elimination may be delayed (some sources prefer atracurium in these patients).

Drug interactions

Other Non-depolarizing Muscle Relaxants

May have a synergistic effect if used concurrently with rocuronium.

Succinylcholine

May speed the onset of action and enhance the neuromuscular blocking actions of rocuronium; do not give rocuronium until succinylcholine effects have subsided.

Aminoglycosides (e.g., gentamicin, amikacin)