Rocuronium bromide (brand names Zemuron, Esmeron), also referred to as "roc",[2] is an aminosteroid non-depolarizing neuromuscular blocker or muscle relaxant used in modern anaesthesia to facilitate tracheal intubation by providing skeletal muscle relaxation for surgery or mechanical ventilation. It is used for standard endotracheal intubation, as well as for rapid sequence induction. It can also be used with other drugs for medical assistance in dying.[3]
Pharmacology
Mechanism of action
Rocuronium bromide is a competitive antagonist for the nicotinic acetylcholine receptors at the neuromuscular junction. Of the neuromuscular-blocking drugs it is considered to be a non-depolarizing neuromuscular junction blocker, because it acts by dampening the receptor action causing muscle relaxation, instead of continual depolarisation which is the mechanism of action of the depolarizing neuromuscular junction blockers, like succinylcholine.
It was designed to be a weaker antagonist at the neuromuscular junction than pancuronium; hence its monoquaternary structure and its having an allyl group and a pyrrolidine group attached to the D ring quaternary nitrogen atom. Rocuronium has a rapid onset and intermediate duration of action.[4]
There is considered to be a risk of allergic reaction to the drug in some patients (particularly those with asthma), but a similar incidence of allergic reactions has been observed by using other members of the same drug class (non-depolarizing neuromuscular blocking drugs).[5]
History
It was introduced in 1994.
Society and culture
Euthanasia
Since 2016, rocuronium bromide has been the standard drug, along with propofol, administered to patients for euthanasia in Canada.[10]
Brand names
Rocuronium bromide is marketed under the brand name Zemuron in the United States and Esmeron in most other countries.
References
- ROCURONIUM-HAMELN (Hameln Pharma Pty Ltd) retrieved 2025-08-25^
- Rocuronium versus succinylcholine: Are they equally effective during rapid-sequence induction of anesthesia? Anesthesia and Analgesia, December 1998^
- Rocuronium versus succinylcholine for rapid sequence induction intubation The Cochrane Database of Systematic Reviews, October 2015