SUGAMMADEX

Absorption

Sugammadex is administered intravenously.

Toxicity

Patients with severe renal impairment (with creatinine clearance below 30 mL/min) should avoid use of drug as their clearance of the drug is reduced and there is inconsistent evidence about its safety in this subset of patients.

Description

Sugammadex is a selective relaxant binding agent indicated for reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide during surgery in adults. Rocuronium bromide and vecuronium bromide are neuromuscular blocking medications that cause temporary paralysis and are especially useful for general anesthesia, ventilation, or tracheal intubation that patients may require for surgery. Sugammadex provides a new treatment option to reverse the effects of those medications and possibly help patients recover sooner post-surgery. Sugammadex (brand name Bridion) is marketed by Merck Sharp and Dohme, and was approved by the United States FDA on December 15, 2015.

The Uses of SUGAMMADEX

6A,6B,6C,6D,6E,6F,6G,6H-octakis-S-(2-carboxyethyl)-6A,6B,6C,6D,6E,6F,6G,6H-octathio-γ-Cyclodextrin, also known as Sugammadex, is used to reverse postoperative residual neuromuscular blockade.

The Uses of SUGAMMADEX

Reversal agent for neuromuscular blocking drugs.

Indications

Sugammadex is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide or vecuronium bromide in adults and pediatric patients ≥2 years old who are undergoing surgery.

Background

Sugammadex is a selective relaxant binding agent indicated for reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide during surgery. Rocuronium bromide and vecuronium bromide are neuromuscular blocking medications that cause temporary paralysis and are especially useful for general anesthesia, ventilation, or tracheal intubation that patients may require for surgery. Sugammadex provides a new treatment option to reverse the effects of those medications and possibly help patients recover sooner post-surgery. Sugammadex (brand name Bridion) is marketed by Merck Sharp and Dohme, and was approved by the United States FDA on December 15, 2015.

Definition

ChEBI: An octasaccharide derivative that is gamma-cyclodextrin in which all eight primary hydroxy groups are replaced by 2-(carboxyethyl)sulfanyl groups. Used (as the octasodium salt) for reversal of neuromuscular blockade induced by rocuronium and vecuronium in adults undergoing surgery.

Synthesis

Bromination of |?-cyclodexdrin 127 with the Vilsmeier-Haack reagent prepared by reaction of bromine with triphenylphospine in DMF gave the per-6-bromo-|?-cyclodextrin 128 in 95-98% yield. Nucleophilic displacement of the bromines of 128 with methyl 3-mercaptopropionate (129) and cesium carbon-ate at 50??C in DMF gave 6-perdeoxy-6-per(2-methoxycarbonylethyl) thio-|?-cyclodextrin 130 as a white powder. Saponification of the esters of 130 was accomplished by reaction with aqueous sodium hydroxide solution to provide sugammadex (XVII) as a glassy solid in 52% yield for the 2 steps.

Metabolism

No metabolites of sugammadex were observed during clinical studies.