This page shows what was measured, who it was measured in, and what that does not settle.
What Sugammadex does in the body
Undoing the paralysis at the end of an operation, quickly and completely, so the breathing tube can come out
Sugammadex is shaped like a bucket made of sugar, with a greasy inside and eight negatively charged arms round the rim. Rocuronium is a greasy molecule carrying a positive charge. It slides into the bucket, the greasy parts stick together and the charges lock, and the pair travels around the bloodstream as one object that cannot reach the muscle. Because the free rocuronium in the blood suddenly drops to almost nothing, the rocuronium already sitting on the muscle receptors leaves and flows back into the blood, where more buckets are waiting. Within minutes the muscle can work again. The whole thing is chemistry between two drugs; the patient is just the container it happens in.
What happened in people
Formation of a one-to-one inclusion complex with rocuronium and vecuronium in plasma, with negligible affinity for benzylisoquinolinium relaxants
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The recorded finding that sits closest to something a person would notice. Written into the record, not signed off, and it carries no population or interval.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
Remains the only marketed drug in routine anaesthesia whose mechanism involves no human molecular target at all
Where it acts
Plasma. Nothing about this drug happens inside a cell, and its only site of action is the bloodstream
Kind of result
A number that stands in for health
Supervision
RNAWiki has not recorded a supervision or regulatory status for this substance.
What the registries record it as
The substance registry classes this as chemical.
FDA substance registry · ERJ6X2MXV7 · read 2026-08-29
Where each sentence above came from
No recorded sentence describes the change this makes in a way that stands on its own. The page opens with what it is taken for instead, and the recorded explanation follows below.
Shown as the opening line on this page.
A limit recorded against this substance. Not signed off as a reviewed claim.
The four opening statements run to 154 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
Absolute difference
An absolute difference is how many more people in a hundred were affected.
A picture of it, and where the picture fails
It is like counting heads in two rooms of a hundred.
Where that stops being true. Heads are easy to count. Study results carry a margin of error too.
What people get wrong. It is confused with a percentage change, which can look far larger.
The arithmetic difference in event rates between arms.
Confidence interval
A confidence interval is the range the true answer is likely to sit in.
A picture of it, and where the picture fails
It is like a weather forecast giving a range rather than one number.
Where that stops being true. A forecast range covers tomorrow. This one covers what the study could resolve.
What people get wrong. The middle number is read as the answer. A range crossing zero means no change is still possible.
An interval estimate that would contain the true parameter in a stated proportion of repeated studies.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
Composite of major postoperative pulmonary complications — pneumonia, respiratory failure or other pulmonary complication
✓ The study showed what it set out to show
Who was studied
STRONGER — sugammadex versus neostigmine and postoperative pulmonary complications
How many people
45712
Study design
Multicentre matched-cohort observational analysis across 12 US hospitals
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
3.5% with sugammadex versus 4.8% with neostigmine; adjusted odds ratio 0.70 (95% CI 0.63 to 0.77); pneumonia 0.53 (0.44 to 0.62); respiratory failure 0.45 (0.37 to 0.56)
Repeated elsewhere
Failed to Replicate
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Observational and matched rather than randomised. Its result is directly contradicted by POPULAR on the identical comparison, and neither design can adjudicate between them.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus injection, as the sodium salt; single-dose vials
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
FDA-approved US prescribing information for sugammadex injection (DailyMed structured product label, Fresenius Kabi USA) — anaphylaxis, marked bradycardia, c… · a recorded source, not a stored snapshot
Incidence of postoperative pulmonary complications from end of surgery to day 28
✗ The study did not show it
Who was studied
POPULAR — post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513)
How many people
22803
Study design
Multicentre prospective observational cohort at 211 hospitals in 28 countries
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Sugammadex versus neostigmine adjusted odds ratio 1.03 (95% CI 0.85 to 1.25), adjusted absolute risk reduction -0.3% (95% CI -2.4 to 1.5); extubation at train-of-four ratio 0.9 or above 1.03 (0.82 to 1.31)
Repeated elsewhere
Failed to Replicate
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. The same study found that giving any reversal agent had an adjusted odds ratio of 1.23 and that using neuromuscular monitoring had 1.31 — every recommended mitigation came back null or worse, which is consistent with confounding by indication rather than with harm.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus injection, as the sodium salt; single-dose vials
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
FDA-approved US prescribing information for sugammadex injection (DailyMed structured product label, Fresenius Kabi USA) — anaphylaxis, marked bradycardia, c… · a recorded source, not a stored snapshot
Nature and frequency of anaphylaxis and hypersensitivity
✓ The study showed what it set out to show
Who was studied
Randomised placebo-controlled repeat-dose hypersensitivity study in healthy volunteers
How many people
375
Study design
Randomised, double-blind, placebo-controlled, parallel-group, repeat-dose study
Compared against
A dummy treatment
Kind of result
A number that stands in for health
What was found
Anaphylaxis in 0.3% of the 299 volunteers who received sugammadex — one case, in the 16 mg/kg group, on the first dose
Repeated elsewhere
Unreplicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The single case occurred on first exposure rather than on repeat dosing, which is the opposite of what a sensitisation model would predict and which the label does not attempt to explain.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus injection, as the sodium salt; single-dose vials
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
FDA-approved US prescribing information for sugammadex injection (DailyMed structured product label, Fresenius Kabi USA) — anaphylaxis, marked bradycardia, c… · a recorded source, not a stored snapshot
What we know
RNAWiki holds 3 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Sugammadex
What a person takes: Sterile aqueous solution for intravenous bolus injection, as the sodium salt; single-dose vials.
The measurement behind this step
There is no formulation problem to solve. The molecule is extremely water-soluble, is not metabolised, does not enter cells and does not cross the blood-brain barrier, so it is presented as a simple aqueous solution and given as a single bolus into a running intravenous line. The dose depends on the depth of block being reversed rather than on time elapsed, because the drug works stoichiometrically — it must outnumber the relaxant present. That relationship, rather than any pharmacokinetic subtlety, is why under-dosing causes recurrence of paralysis.
Getting in
Injected into a vein, and it stays there
The molecule is large, heavily charged and extremely water-soluble. It does not enter cells, does not cross into the brain, and does not bind anything in the body.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
At 2,002 daltons with eight carboxylate groups, sugammadex is confined to the extracellular space and is not metabolised. It is excreted essentially unchanged by the kidney, which is why renal function governs how long it and its complex remain in circulation, and why waiting times before giving another relaxant are longer in renal impairment.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
The molecule is a ring of eight sugars with a greasy hole in the middle. The greasy steroid skeleton of rocuronium fits into that hole.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The gamma-cyclodextrin cavity is hydrophobic and its diameter was the design constraint: the seven-unit beta ring is too narrow for an androstane guest. Inclusion is driven by the hydrophobic effect, with the steroid nucleus displacing ordered water from the cavity.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
Eight negatively charged arms hang off the rim of the ring. Rocuronium carries a positive charge, and the arms hold onto it so it cannot slip back out.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The thioether-linked carboxylate arms were the tuned element of the original design programme, with arm length chosen so the negative charges sit at the right distance to interact with the quaternary ammonium of the guest. The result is a one-to-one complex with high affinity for rocuronium, lower for vecuronium, and essentially none for benzylisoquinolinium relaxants such as cisatracurium.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
Free rocuronium in the blood collapses toward zero
With enough cages circulating, there is almost no unbound rocuronium left in the bloodstream.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Because sequestration is stoichiometric rather than competitive, the free plasma concentration falls in proportion to how much sugammadex is present, with no ceiling. This is the structural difference from neostigmine, which raises junctional acetylcholine to compete with the relaxant and can raise it no further once acetylcholinesterase is fully inhibited.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
The relaxant leaves the muscle because the gradient reversed
Nothing is done to the muscle at all. The drug sitting on the receptors simply diffuses back into the blood, because that is now where the empty space is.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Rocuronium leaves the neuromuscular junction down its own concentration gradient into plasma, where further sugammadex captures it. Receptor occupancy falls, endplate potentials recover above threshold and neuromuscular transmission resumes. Because the mechanism is removal rather than competition, it works from profound block — where an anticholinesterase has no effect at all.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
The cage and its captive are excreted in the urine as a single unit, unchanged.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The complex is cleared renally without metabolism. Two consequences follow directly. In renal impairment the complex persists, which is why the label sets longer waiting times before another steroid relaxant may be given. And if too little sugammadex is given for the amount of relaxant present, the complex can dissociate as free drug is cleared, producing recurrence of paralysis — a labelled risk both from under-dosing and from displacement by a competing guest such as toremifene.
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 6 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
Adults and children over two who have received rocuronium or vecuronium during surgery. It does nothing whatsoever for succinylcholine, cisatracurium or atracurium.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “The safety and effectiveness of sugammadex injection for reversal of neuromuscular blockade induced by rocuronium bromide or vecuronium bromide have been established in pediatric patients aged 2 years and older.”
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
On older people, the label states: “Sugammadex injection has been administered in a dedicated clinical study to a total 102 geriatric patients that compared the time to recovery from neuromuscular blockade induced by rocuronium (0.6 mg/kg) following administration of 2 mg/kg sugammadex given at the reappearance of T 2 in 65 to 74 year-olds (N=62) and ≥75 year-olds (N=40) compared with 18 to 64 year-olds (N=48).”
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
On people who are pregnant, the label states: “Risk Summary There are no clinical trial data on sugammadex use in pregnant women to inform any drug-associated risks.”
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
On people who are breastfeeding, the label states: “Risk Summary No data are available regarding the presence of sugammadex in human milk, the effects of sugammadex on the breast fed infant, or the effects of sugammadex on milk production.”
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
On people with reduced liver function, the label states: “Sugammadex is not metabolized nor excreted by the liver; therefore, dedicated trials in patients with hepatic impairment have not been conducted.”
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
On people with reduced kidney function, the label states: “This drug is known to be substantially excreted by the kidney.”
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
Where the result stopped carrying
The pulmonary outcome case failed to replicate: STRONGER found a 30% reduction and POPULAR found none, on the same comparison
The surrogate itself failed its own test in POPULAR, where extubation at a train-of-four ratio of 0.9 or above was not associated with better outcomes
United States approval failed for seven years and five months after European authorisation, on a safety signal rather than on efficacy
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Given by a clinician
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Sterile aqueous solution for intravenous bolus injection, as the sodium salt; single-dose vials
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
RNAWiki has not recorded a supervision or regulatory status for this substance.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
No register row and no identity class settled the question.
No source is stored against this line.
What is in the pack
There is no formulation problem to solve.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold. The rest of the recorded wording: The molecule is extremely water-soluble, is not metabolised, does not enter cells and does not cross the blood-brain barrier, so it is presented as a simple aqueous solution and given as a single bolus into a running intravenous line. The dose depends on the depth of block being reversed rather than on time elapsed, because the drug works stoichiometrically — it must outnumber the relaxant present. That relationship, rather than any pharmacokinetic subtlety, is why under-dosing causes recurrence of paralysis.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
The label leads with anaphylaxis and hypersensitivity, characterised prospectively at 0.3% in 299 healthy volunteers. It warns of marked bradycardia, some cases resulting in cardiac arrest, within minutes of administration, and instructs monitoring with anticholinergic treatment if needed. Ventilatory support is mandatory until spontaneous respiration and airway patency are assured, because paralysis can persist or recur. Recurrence can also follow under-dosing or displacement of the relaxant from the complex by another drug, with the risk greatest over about three elimination half-lives. Hormonal contraception is rendered less effective and an additional non-hormonal method is required for seven days. Waiting times before a steroid relaxant may be given again are longer in renal impairment, and a non-steroidal relaxant should be considered instead. No dosing guidance appears on this page.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Where this came from
Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based sy… · a recorded source, not a stored snapshot
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Sterile aqueous solution for intravenous bolus injection, as the sodium salt; single-dose vials
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
A recorded note compares this form with the others that are sold. It is kept below, word for word.
§ A fixed RNAWiki sentence
Where this came from
Wording RNAWiki always uses, not a finding about this substance.
The recorded note, unchanged: The molecule is extremely water-soluble, is not metabolised, does not enter cells and does not cross the blood-brain barrier, so it is presented as a simple aqueous solution and given as a single bolus into a running intravenous line. The dose depends on the depth of block being reversed rather than on time elapsed, because the drug works stoichiometrically — it must outnumber the relaxant present. That relationship, rather than any pharmacokinetic subtlety, is why under-dosing causes recurrence of paralysis.
No source is stored against this line.
What is recorded as being sold
69 products list this as an active ingredient in the United States drug directory. 69 of them contain it and nothing else.
FDA National Drug Code directory · 48087-0151 · read 2026-08-29
They are sold as injection, injection, solution, powder and solution, taken intravenous.
FDA National Drug Code directory · 48087-0151 · read 2026-08-29
The regulator's established pharmacologic class for it is gamma-cyclodextrins [cs].
FDA National Drug Code directory · 48087-0151 · read 2026-08-29
23 published labels name it as an active ingredient. 23 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-29
Those labels are classed as human prescription drug.
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-29
Sugammadex is intravenous at 3 DOSAGE FORMS AND STRENGTHS Sugammadex injection is a sterile, clear, colorless to slightly yellow-brown, non-pyrogenic aqueous solution intended for intravenous infusion., recorded as fda label in effect 2026-02-18 in the United States.
US prescribing information · 4f90c37e-3505-0968-38fd-fc7e4dd66e82 · read 2026-08-30
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
RNAWiki could not confidently classify this substance, so no self-experiment plan is offered.
Questions worth asking
Which of the trials of Sugammadex studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That faster reversal to a train-of-four ratio of 0.9 delivers fewer pulmonary complications — the two largest studies of it disagree and no randomised outcome trial exists
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the train-of-four ratio is itself a patient outcome; extubating at 0.9 or above had an odds ratio of 1.03 in the study that checked
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That a drug with no human target has a correspondingly clean safety profile — the label leads with anaphylaxis and warns of bradycardia progressing to cardiac arrest
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That capturing rocuronium is all the cavity does; it also captures progestogens, and that is a labelled consequence for the patient
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Sugammadex are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
A drug designed as a container, and it works exactly as designed
In plain words
Chemists set out to build a molecule that would swallow rocuronium rather than compete with it. They published the working molecule in 2002. It does precisely that, and it is the reason a deep paralysis can now be abolished in minutes.
What was measured
Formation of a one-to-one inclusion complex with rocuronium and vecuronium in plasma, with negligible binding to benzylisoquinolinium relaxants
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Bom and colleagues at Organon Research in Newhouse published the concept of chemical encapsulation of rocuronium by a cyclodextrin-based synthetic host in 2002. The design took a gamma-cyclodextrin — a ring of eight glucose units with a hydrophobic interior — and extended the rim with eight thioether-linked carboxylate arms, so that the hydrophobic androstane core of rocuronium enters the cavity while its quaternary ammonium is held electrostatically by the arms. The approved label describes the mechanism in the same terms: a modified gamma cyclodextrin that forms a complex with rocuronium and vecuronium and reduces the amount available to bind nicotinic receptors at the neuromuscular junction. This is unusual enough to be worth stating plainly: sugammadex has no human target, no receptor, no enzyme and no transporter. Its pharmacodynamics are the chemistry of two drugs meeting in plasma, and the patient is the vessel.
Written into the record, not signed off as a reviewed claim
Two large studies of the same question reached opposite answers
In plain words
Does reversing with sugammadex instead of the older drug mean fewer lung complications after surgery? A study of 45,712 American patients said 30% fewer. A study of 22,803 European patients said no difference at all. Neither was randomised.
What was measured
That reversing with sugammadex reduces postoperative pulmonary complications — an inference supported by one large matched cohort, contradicted by another large prospective cohort, and never tested in a randomised outcome trial
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
STRONGER matched 22,856 sugammadex patients to 22,856 neostigmine patients across 12 United States hospitals, exact-matching on institution, sex, age, comorbidity, obesity, procedure type and relaxant. The composite of major postoperative pulmonary complications occurred in 3.5% versus 4.8%, giving an adjusted odds ratio of 0.70 (95% CI 0.63 to 0.77); pneumonia 1.3% versus 2.2%, adjusted odds ratio 0.53 (0.44 to 0.62); respiratory failure 0.8% versus 1.7%, adjusted odds ratio 0.45 (0.37 to 0.56). POPULAR prospectively followed 22,803 patients at 211 hospitals in 28 European countries with a physical examination within three days of surgery, and found the choice of sugammadex rather than neostigmine had an adjusted odds ratio of 1.03 (95% CI 0.85 to 1.25) for postoperative pulmonary complications, with an adjusted absolute risk reduction of -0.3% (95% CI -2.4 to 1.5). In the same dataset, giving any reversal agent had an odds ratio of 1.23 and extubating at a train-of-four ratio of 0.9 or above had an odds ratio of 1.03. Both studies are large, both are observational, and both are subject to different confounding — STRONGER to institutional practice differences that matching cannot fully absorb, POPULAR to selection of sicker patients into more intensive management. No randomised trial has tested sugammadex against neostigmine on a clinical outcome. The honest position is that the surrogate benefit is certain and the outcome benefit is unresolved.
Written into the record, not signed off as a reviewed claim
Anaphylaxis at 0.3% in the study built to look for it
In plain words
Rather than relying on reports coming in after approval, a randomised placebo-controlled study gave healthy volunteers repeated doses specifically to characterise hypersensitivity. One in 299 had anaphylaxis.
What was measured
Frequency of anaphylaxis in 299 healthy volunteers in a randomised placebo-controlled repeat-dose study
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The label describes a randomised, double-blind, placebo-controlled, parallel-group, repeat-dose study in which 375 subjects received three doses with a five-week washout: 151 at 4 mg/kg, 148 at 16 mg/kg and 76 on placebo. The frequency of anaphylaxis among the 299 healthy volunteers who received sugammadex was 0.3%, a single case in the 16 mg/kg group on the first dose, with conjunctival oedema, urticaria, erythema, swelling of the uvula and a reduction in peak expiratory flow. This is a better class of evidence than most hypersensitivity data, because it is a prospective randomised design with a defined denominator rather than a spontaneous reporting rate, and it is worth noting that the case occurred on first exposure. The label carries anaphylaxis and hypersensitivity as its lead warning and instructs clinicians to be prepared for it.
Source
FDA-approved US prescribing information for sugammadex injection, Warnings and Precautions 5.1 — Anaphylaxis and Hypersensitivity (DailyMed SPL 8e685b67-6804-4d97-b43e-0259b3fe231f)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
Marked bradycardia, some of it cardiac arrest, within minutes of administration
In plain words
The label warns that the heart rate can drop severely within minutes of giving this drug, and that some of those episodes have ended in cardiac arrest.
What was measured
Labelled warning of marked bradycardia and cardiac arrest within minutes of administration, without a stated incidence
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The approved label states that cases of marked bradycardia, some of which have resulted in cardiac arrest, have been observed within minutes after administration of sugammadex, and instructs monitoring for haemodynamic changes with administration of an anticholinergic such as atropine if clinically significant bradycardia occurs. This warning is worth setting against the usual framing of the drug, which contrasts it favourably with neostigmine precisely because neostigmine requires a co-administered antimuscarinic to prevent bradycardia. Sugammadex is given without routine antimuscarinic cover and can still produce the same effect. The mechanism is not established, and no incidence is stated on the label, so none is stated here.
Source
FDA-approved US prescribing information for sugammadex injection, Warnings and Precautions 5.2 — Marked Bradycardia
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
The cage also captures hormonal contraceptives, and the label says so
In plain words
The same cavity that swallows rocuronium swallows progestogens. Anyone using hormonal contraception is told to use an additional non-hormonal method for seven days after receiving this drug.
What was measured
Labelled requirement for seven days of additional non-hormonal contraception, and labelled displacement interaction with toremifene
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The label states that certain drugs, including hormonal contraceptives, could become less effective because sugammadex lowers their free plasma concentration, and instructs that patients must use an additional non-hormonal method of contraception for seven days after administration. It also names toremifene, which has a relatively high binding affinity for sugammadex and may reach relatively high plasma concentrations, as capable of displacing rocuronium or vecuronium from the complex and delaying recovery to a train-of-four ratio of 0.9. The label states that its interaction assessments are based on binding affinity, preclinical experiments, clinical studies and pharmacokinetic-pharmacodynamic simulation, and that no clinically significant pharmacodynamic interactions are expected other than these two. This audit is on the page because it is the clearest consequence of a drug whose mechanism is promiscuous molecular capture: the cavity does not know what it is supposed to catch.
Source
FDA-approved US prescribing information for sugammadex injection, Warnings and Precautions 5.6 and Drug Interactions 7.1 to 7.3
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
Seven and a half years between European and American approval
In plain words
Europe authorised this drug in July 2008. The United States approved it in December 2015. The reversal effect was never in question for either regulator.
What was measured
That regulatory approval of a reversal agent turns on its reversal efficacy — when the efficacy was never disputed and the seven-year divergence was entirely about a safety signal
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The European Medicines Agency granted marketing authorisation for Bridion on 25 July 2008 to Merck Sharp & Dohme B.V. The United States Food and Drug Administration approved the original application, NDA 022225, on 15 December 2015 — a gap of seven years and five months, during which the drug was in routine use across Europe and unavailable in the United States. Both regulators had the same neuromuscular efficacy data. What separates them is how each weighed the hypersensitivity signal, and the eventual United States label leads with anaphylaxis as its first warning and cites a dedicated randomised repeat-dose study of 375 subjects designed to characterise it. This entry is filed as a change of position rather than a failure because nothing about the drug changed across those years: the same molecule, the same surrogate endpoint and the same efficacy were judged sufficient in one jurisdiction and insufficient in another for most of a decade.
Source
European Medicines Agency EPAR for Bridion, marketing authorisation dated 25 July 2008; FDA Drugs@FDA record for NDA 022225, original approval 15 December 2015
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
Every efficacy claim is anchored to a number on a nerve monitor
In plain words
The endpoint in every trial is the train-of-four ratio reaching 0.9. That is a measurement of muscle twitch, not of anything a patient experiences, and the one large study that tested whether reaching it improves outcomes found no association.
What was measured
That restoring the train-of-four ratio to 0.9 or above delivers the clinical benefit the ratio is used to represent
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
A train-of-four ratio is the height of the fourth twitch divided by the first, in response to four electrical stimuli delivered to a peripheral nerve. A ratio of 0.9 became the accepted threshold for adequate recovery because below it pharyngeal function and upper airway patency are measurably impaired in volunteers. Sugammadex reaches that threshold faster and from deeper blocks than neostigmine can, reliably and reproducibly, and that is the basis of its licence. The chain from there to a patient outcome has one weak link and one broken one. The weak link is that residual block is associated with pulmonary complications in observational data. The broken link is POPULAR, which found that extubating at a train-of-four ratio of 0.9 or above had an adjusted odds ratio of 1.03 (95% CI 0.82 to 1.31) for postoperative pulmonary complications — the surrogate itself did not track the outcome. This does not mean the surrogate is meaningless; it means the inference from the surrogate to the outcome has been tested once at scale and did not hold.
This order is fixed in code and does not count clicks or time on the page.
What is not here
7 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What was measured, goal by goal — found nothing in the sources checked.
How close this is to real life — found nothing in the sources checked.
Felt, measured, or meaningful — found nothing in the sources checked.
How long anything takes — found nothing in the sources checked.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
Everything above is built from what is below. This layer keeps the technical vocabulary, record identifiers and every stored row, so a reader who wants to check the page can.
The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A designed molecular cage that reverses rocuronium by capturing it in plasma rather than by acting on the patient at all — reliable and fast at its surrogate endpoint, and split down the middle on outcomes, with one matched cohort of 45,712 patients finding 30% fewer pulmonary complications (adjusted odds ratio 0.70) and a prospective cohort of 22,803 finding none at all (adjusted odds ratio 1.03).
Recorded evidence blocks (7)
Q1
On the Sugammadex label: indicated for what?
"Sugammadex Injection is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adult and pediatric patients aged 2 years and older undergoing surgery. Additional pediatric use information is approved for Merck Sharp & Dohme LLC's BRIDION ® (sugammadex) injection.": indications and usage on Sugammadex's label. DailyMed label · 70c00636-d4ba-4939-802c-9d5a92435c93 · 2026-08-03
Q2
202 registered trials of Sugammadex — at which phases?
Registered studies posting no result
124 of 202
202 registered studies of Sugammadex: 94 phase4, 39 na, 36 phase3, 15 na or unstated, 15 phase2, 6 phase1, 1 early phase1. CLINICALTRIALS_SNAPSHOT · 2026-09-01
250 with a PubMed record
Show the evidence
phase4
94
na
39
phase3
36
na or unstated
15
phase2
15
phase1
6
8 more recorded rows
early phase1
1
completed
150
unknown
30
withdrawn
7
recruiting
6
terminated
5
not yet recruiting
3
enrolling by invitation
1
recorded 2026-09-01 · last checked 2026-09-04
Q3
11 of Sugammadex's trials stopped: accrual/recruitment, funding/business, other?
"Low recruiting rate due to not activation of some collaborator centers"; 11 of 202 registered studies
Show the evidence
Trial
NCT02256280
terminated; "Low recruiting rate due to not activation of some collaborator centers"
NCT02825576
terminated; "Lack of Study Personnel"
NCT02888067
terminated; "Slow recruitment"
NCT03226080
withdrawn; "Study terminated with IRB on 20Feb2019 due to lack of enrollment."
NCT03276026
terminated; "PI left the Institution."
NCT03369782
withdrawn; "refocusing of research priorities"
5 further recorded trials
NCT03574337
withdrawn; "Inadequate funding"
NCT03944473
withdrawn; "Stopped before IRB approval"
NCT04556721
withdrawn; "Difficulty and lack of recruitment of the patients"
NCT05256901
terminated; "Study was terminated due to lack of funding."
NCT05664633
withdrawn; "technical aspects - unable to continue with the study. Investigator left institution. No patients enrolled."
recorded 2026-09-01 · last checked 2026-09-04
Q4
Human studies of Sugammadex used Sugammadex 0.5 mg/kg — over how long?
Human studies of Sugammadex used "Sugammadex 0.5 mg/kg". ClinicalTrials.gov · 2026-09-01
14 recorded entries; human; also "Sugammadex 1 mg/kg", "Sugammadex 2 mg/kg", "Sugammadex 4 mg/kg"
Show the evidence
human
NCT00421148
Sugammadex 0.5 mg/kg
NCT00421148
Sugammadex 1 mg/kg
NCT00421148
Sugammadex 2 mg/kg
NCT00421148
Sugammadex 4 mg/kg
NCT01301261
Sugammadex 16mg/kg
NCT01785758
Sugammadex (4 mg/Kg)
8 more recorded rows
humanNCT02888067
Sugammadex sodium 2 mg/kg
humanNCT02888067
Sugammadex sodium 4 mg/kg
humanNCT03346057
Sugammadex 16 mg/kg
humanNCT03689413
Sugammadex 200 MG in 2 ML Injection
humanNCT04263363
Sugammadex 100 MG/ML [Bridion]
humanNCT04851574
Sugammadex 100Mg/ml Intravenous Solution
humanNCT06035757
Bridion 200 MG in 2 ML Injection
humanNCT06334562
SUGAMMADEX SODIUM 100 Mg in 1 mL
recorded 2026-09-01 · last checked 2026-09-04
Q5
Sugammadex's half-life is 8 days — which schedules were studied?
8 days, the half-life Sugammadex's label states: "In nonclinical drug distribution studies, sugammadex is retained in sites of active mineralization, such as bone and teeth, with a mean half-life of 172 and 8 days, respectively [see Use in Specific Populations (8.4), Nonclinical Toxicology (13.2)] ." DailyMed label · 70c00636-d4ba-4939-802c-9d5a92435c93 · 2026-08-03
Show the evidence
half lifepharmacokinetics
8 days; In nonclinical drug distribution studies, sugammadex is retained in sites of active mineralization, such as bone and teeth, with a mean half-life of 172 and 8 days, respectively [see Use in Specific Populations (8.4), Nonclinical Toxicology (13.2)] .
metabolismpharmacokinetics
Metabolism In clinical studies, no metabolites of sugammadex have been observed and only renal excretion of the unchanged product was observed as the route of elimination.
recorded 2026-08-03 · last checked 2026-09-04
Q6
Which 64 trials of Sugammadex posted no result?
Posted no result
64 of 64 completed trials
Registrations
NCT00379613, NCT00482599, NCT00420680, NCT00451100, NCT01006720 and NCT01142648, and 58 more
Completion dates
oldest 2004-07-14; newest 2024-08-29
Show the evidence
Trial
NCT00379613
2004-07-14
NCT00482599
2006-04-13
NCT00420680
2006-08-01
NCT00451100
2006-08-29
NCT01006720
2009-12
NCT01142648
2010-03
14 further recorded trials
NCT00953550
2011-02
NCT01101139
2011-06
NCT01785758
2012-01
NCT01509651
2012-04
NCT01503840
2012-07
NCT01539044
2013-06
NCT05313100
2013-08
NCT01809886
2013-12
NCT01890057
2014-01
NCT02079337
2014-04
NCT02160223
2014-06
NCT01980069
2014-10
NCT02215382
2014-11
NCT01579851
2015-01
Q7
At the median, Sugammadex's trials enrolled 80 people — anything larger?
Median enrolment
80
Largest enrolment
30430
Registered trials counted
202
Where it is registeredIdentifiers, relations and other names
ClinicalTrials.gov — US Government work · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
✗ required summary fields resolved: 4 required field(s) not terminal: Why people use it, Best-supported result, Biggest unanswered question, Human evidence
✓ public claims reviewed: 0 reviewed claim(s); drafts are never rendered
✓ source coverage passed: 5 source rows
✓ no critical contamination: no quarantine open
✓ canonical metadata passed: slug and display name present
✓ no raw internal fields: enforced by the copy-contract test over the rendered page
This is a record of evidence. It is not medical advice, and it does not say this substance suits you. Nothing here says any substance on RNAWiki is appropriate for a child.