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Rocuronium 50 mg/5mL Injection, Solution — NDC 66794-0228-41 package photo
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Rocuronium 50 mg/5mL Injection, Solution — NDC 66794-228-41 (Billing 66794-0228-41)

by Piramal Critical Care Inc · 10 VIAL in 1 CARTON / 5 mL in 1 VIAL

This is a package of Rocuronium 50 mg/5mL Injection, Solution from Piramal Critical Care Inc, marketed since Jul 2020 and currently FDA-listed; retail pharmacies pay about $0.3942 per mL (NADAC). It is this product's only package size.

NDC 66794-0228-41
🏷️ FDA NDC (as labeled) 66794-228-41 billing pads the product segment with a zero
Rx only Generic On market Non-controlled ⚠ On shortage ⇄ Compare with another NDC
🗂️ FDA directory synced Oct 1, 2026 · this listing last changed Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

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Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

NDC database record

One package, one record: these facts belong to NDC 66794-228-41 alone.

Record
FDA NDC Directory package listing · Human prescription drug
Code segments
66794 labeler · 228 product · 41 package
Package marketed since
Jul 20, 2020
Sample package
No — commercial package
Listing certified through
Dec 31, 2026
Barcode (UPC)
0366794228021
Medicaid fills, this package
617 prescriptions in the last four reported quarters
FDA record last changed
Jul 24, 2026
⚠️
Active FDA shortage. Rocuronium Bromide Injection is currently reported in shortage by the FDA. Available Shortage details →

Identity & classification

Regulatory identifiers FDA, NLM and CMS codes for this package

FDA NDC (as labeled) 66794-228-41
Product NDC 66794-228
11-digit billing NDC 66794022841
NCPDP billing unit ML — per mL (volume)
RxCUI 1234995
UNII I65MW4OFHZ
UPC 0366794228021
Application # ANDA210437
SPL Set ID 98255b70-51f9-8d16-e053-2995a90a8f97
Established class (EPC) Nondepolarizing Neuromuscular Blocker
Physiologic effect Neuromuscular Nondepolarizing Blockade
DEA schedule Non-controlled
Marketing category ANDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2020-07-20
Route INTRAVENOUS
Dosage form INJECTION, SOLUTION
Substance ROCURONIUM BROMIDE
TE code (Orange Book) AP · RLD · RS

Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification

GPI-14 74200047102020
GPI class Rocuronium Bromide
GCN Seq No 021727
GCN 37201
HICL code 008963
Ingredient (HICL) Rocuronium Bromide
HIC1 code S
Therapeutic class — broad (HIC1) Locomotor System
HIC2 code S7
Therapeutic class — intermediate (HIC2) Affect Primarily Skeletal Muscle
HIC3 code S7A
Therapeutic class — specific (HIC3) Neuromuscular Blocking Agents
AHFS code 12:20.20.00
AHFS class Neuromuscular Blocking Agents
FDB label name ROCURONIUM 50 MG/5 ML VIAL
FDB brand name Rocuronium Bromide
Legend status F — Federal legend — prescription drug or device
Quick answers
  • GSN (GCN sequence number): 021727
  • GCN: 37201
  • GPI-14 (Medi-Span): 74200047102020
  • HICL (First Databank): 008963
  • AHFS class code: 12:20.20.00
  • RxCUI (RxNorm): 1234995
Why two NDCs? The FDA registers this code as 66794-228-41 — a 5-3-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the product segment → 66794-0228-41. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

RxNorm drug class

This medicine belongs to the Nondepolarizing Neuromuscular Blocker class.

Pharmacologic class Nondepolarizing Neuromuscular Blocker
Drug family (ATC) Other quaternary ammonium compounds
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

Clinical

Label name ROCURONIUM 50 MG/5 ML VIAL Ingredient Rocuronium Bromide
📗 Our plain-language guide HelloPharmacist
  • It relaxes your muscles during general anesthesia. That helps the team place a breathing tube and keeps you still during surgery or while you are on a ventilator. You will also be...
  • Only through an IV by trained anesthesia staff in a hospital or surgical setting. You won't take it yourself. They adjust the dose for you and use a nerve stimulator to track how i...
  • Most people notice little. Temporary changes in blood pressure are the most common effect. Less often, people have a fast heartbeat, nausea, vomiting, rash, itching or hiccups. You...
  • Tell them about any past allergic reaction to a muscle relaxant. Also mention myasthenia gravis, liver disease, heart or lung blood vessel problems, and any medicines you take, suc...
📖 Read our full Rocuronium guide →

Supplement & herbal interactions

Some supplements/herbs that may interact with Rocuronium — tap one for details:

ProcaineMajor LithiumModerate MagnesiumModerate
🌿 Every supplement checked against Rocuronium (3 interactions) — ranked by severity →
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer mLPer package
Retail pharmacies payNADAC · weekly $0.394 $19.71 / 50 ml
Medicaid paysCMS SDUD · 12 mo $16.24 $811.87 / 50 ml
Medicare drug plans payPart D · quarterly No Part D plan price is available for this NDC in our data.
NADAC price history (per mL) — tap or hover for the price & month
Mar 2026 Apr 2026 $0.394 $0.394
Flat over the last 2 months.
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

Packaging — all sizes for this product

Package NDCDescription Marketing startMarketing endStatus
66794-0228-41 You're viewing this Main listing 10 VIAL in 1 CARTON / 5 mL in 1 VIAL 2020-07-20 — Active

Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Rocuronium Bromide 10 mg/mL 00143-9250-10 Hikma 10 vials $0.394 AP Availability likely —
rocuronium bromide 10 mg/mL 00409-1403-10 Hospira, 10 vials $0.394 AP Availability likely —
rocuronium bromide 10 mg/mL 00409-3189-10 Hospira, 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 00409-9558-49 Hospira, 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 25021-0687-05 Sagent 10 vials $0.394 AP Availability likely —
rocuronium bromide 10 mg/mL 39822-4200-02 XGen 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 50 mg/5mL 43066-0007-10 Baxter 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 50 mg/5mL 43547-0530-10 Solco 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 50 mg/5mL 55150-0225-05 Eugia 10 vials $0.394 AP Availability likely —
Rocuronium 10 mg/mL 63323-0426-05 Fresenius 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 65145-0130-10 Caplin 10 vials $0.394 AP Availability likely —
Rocuronium 10 mg/mL 65219-0065-05 Fresenius 10 vials $0.394 AP Availability likely —
Rocuronium 50 mg/5mLthis 66794-0228-41 Piramal 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 67457-0228-05 Mylan 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 50 mg/5mL 70756-0669-10 Lifestar 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 71288-0700-06 Meitheal 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 71839-0141-10 BE 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 72572-0650-10 Civica, 10 vials $0.394 AP Availability likely —
Rocuronium 10 mg/mL 81565-0204-02 Phlow 10 vials $0.394 AP Availability likely —
Rocuronium Bromide 10 mg/mL 00143-9251-10 Hikma 10 vials — AP FDA listed —
rocuronium bromide 10 mg/mL 00409-5160-10 Hospira, 10 vials — AP FDA listed —
rocuronium bromide 10 mg/mL 00409-7037-10 Hospira, 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 00781-3220-92 Sandoz 10 vials — AP FDA listed —
Rocuronium Bromide 50 mg/5mL 42677-0309-10 Shandong 10 vials — AP FDA listed —
Rocuronium Bromide 100 mg/10mL 42677-0310-10 Shandong 10 vials — AP FDA listed —
Rocuronium Bromide 100 mg/10mL 43066-0013-10 Baxter 10 vials — AP FDA listed —
Rocuronium Bromide 100 mg/10mL 43547-0531-10 Solco 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 51662-1354-01 HF 5 ml — AP FDA listed —
Rocuronium Bromide 10 mg/mL 51662-1355-01 HF 10 ml — AP FDA listed —
Rocuronium Bromide 100 mg/10mL 51662-1545-01 HF 10 ml — AP FDA listed —
Rocuronium Bromide 50 mg/5mL 51662-1546-01 HF 5 ml — AP FDA listed —
Rocuronium Bromide 10 mg/mL 51662-1640-01 HF 5 ml — AP FDA listed —
Rocuronium Bromide 100 mg/10mL 55150-0226-10 Eugia 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 65145-0131-10 Caplin 10 vials — AP FDA listed —
Rocuronium 100 mg/10mL 66794-0229-41 Piramal 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 68083-0364-10 Gland 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 68083-0365-10 Gland 10 vials — AP FDA listed —
Rocuronium Bromide 100 mg/10mL 70756-0670-10 Lifestar 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 71288-0718-11 Meitheal 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 71839-0142-10 BE 10 vials — AP FDA listed —
rocuronium bromide 10 mg/mL 71872-7036-01 Medical 1 vial — AP FDA listed —
Rocuronium Bromide 10 mg/mL 71872-7207-01 Medical 1 vial — AP FDA listed —
Rocuronium Bromide 50 mg/5mL 71872-7262-01 Medical 1 vial — AP FDA listed —
rocuronium bromide 10 mg/mL 71872-7309-01 Medical 1 vial — AP FDA listed —
Rocuronium Bromide 10 mg/mL 71872-7317-01 Medical 1 vial — AP FDA listed —
Rocuronium Bromide 10 mg/mL 71872-7344-01 Medical 1 vial — AP FDA listed —
Rocuronium 100 mg/10mL 71872-7349-01 Medical 1 vial — AP FDA listed —
Rocuronium Bromide 10 mg/mL 71872-7372-01 Medical 1 vial — AP FDA listed —
Rocuronium 50 mg/5mL 72162-2263-02 Bryant 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 72572-0651-10 Civica, 10 vials — AP FDA listed —
Rocuronium Bromide 50 mg/5mL 82449-0001-02 STERISCIENCE 10 vials — AP FDA listed —
Rocuronium Bromide 10 mg/mL 84549-0131-10 ProPharma 10 ml — AP FDA listed —
Rocuronium Bromide 10 mg/mL 84549-0141-10 ProPharma 5 ml — AP FDA listed —
About this product: this is a generic version of the medicine. FDA equivalence ratings are shown when available, and other versions are listed above, least expensive first.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2020
On the market since
Jul 2020
📍
2026
Currently FDA-listed
6 years listed
🔓
·
Generic on the market
this product is a generic
✅This is a generic drug

This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

Loading inactive ingredients from the official FDA label in the background. No external source is being called by this page request.
Where does this data come from?
Source: official FDA Structured Product Labeling (SPL) via DailyMed and the openFDA label index. Structured IACT rows and label-wide narrative are kept separate; availability and product-level specificity depend on the submitted label.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

Manufacturer & labeler

LabelerPiramal Critical Care Inc
Application holderPIRAMAL CRITICAL CARE INC
FDA applicationANDA210437 (ANDA)
Labeler code66794
First marketedJul 2020
Product typeHuman Prescription Drug
Portfolio23 products on file

More NDCs from Piramal Critical Care Inc labeler code 66794

The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage ⏱️ Dosage and Administration 💊 Dosage Forms and Strengths ⛔ Contraindications ⚠️ Warnings and Cautions 🤒 Adverse Reactions 🔄 Drug Interactions 👥 Use in Specific Populations 🆘 Overdosage 🧬 Clinical Pharmacology 📦 How Supplied / Storage and Handling 📋 Description
🎯 Indications and Usage 78 words ▾

1 INDICATIONS AND USAGE Rocuronium bromide injection is indicated for inpatients and outpatients as an adjunct to general anesthesia to facilitate both rapid sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Rocuronium bromide injection is a nondepolarizing neuromuscular blocking agent indicated as an adjunct to general anesthesia to facilitate both rapid sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

( 1 )

⏱️ Dosage and Administration ~3 min read ▾

2 DOSAGE AND ADMINISTRATION

2.1Important Dosing and Administration Information Rocuronium bromide injection is for intravenous use only. This drug should only be administered by experienced clinicians or trained individuals supervised by an experienced clinician familiar with the use, actions, characteristics and complications of neuromuscular blocking agents. Doses of rocuronium bromide injection should be individualized and a peripheral nerve stimulator should be used to monitor drug effect, need for additional doses, adequacy of spontaneous recovery or antagonism, and to decrease the complications of overdosage if additional doses are administered.

The dosage information which follows is derived from studies based upon units of drug per unit of body weight. It is intended to serve as an initial guide to clinicians familiar with other neuromuscular blocking agents to acquire experience with rocuronium bromide. In patients in whom potentiation of, or resistance to, neuromuscular block is anticipated, a dose adjustment should be considered [see Dosage and Administration ( 2.6 ), Warnings and Precautions ( 5.10, 5.13 ), Drug Interactions ( 7.2, 7.3 , 7.4, 7.5, 7.6, 7.8, 7.10 ), and Use in Specific Populations ( 8.6 ) ].

Risk of Medication Errors Accidental administration of neuromuscular blocking agents may be fatal. Store rocuronium bromide injection with the cap and ferrule intact and in a manner that minimizes the possibility of selecting the wrong product [see Warnings and Precautions ( 5.3 )].

2.2Dose for Tracheal Intubation The recommended initial dose of rocuronium bromide, regardless of anesthetic technique, is 0.6 mg/kg. Neuromuscular block sufficient for intubation (80% block or greater) is attained in a median (range) time of 1 (0.4 to 6) minute(s) and most patients have intubation completed within 2 minutes. Maximum blockade is achieved in most patients in less than 3 minutes.

This dose may be expected to provide 31 (15 to 85) minutes of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia. Under halothane, isoflurane, and enflurane anesthesia, some extension of the period of clinical relaxation should be expected [see Drug Interactions ( 7.3 ) ]. A lower dose of rocuronium bromide (0.45 mg/kg) may be used.

Neuromuscular block sufficient for intubation (80% block or greater) is attained in a median (range) time of 1.3 (0.8 to 6.2) minute(s) and most patients have intubation completed within 2 minutes. Maximum blockade is achieved in most patients in less than 4 minutes. This dose may be expected to provide 22 (12 to 31) minutes of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia.

Patients receiving this low dose of 0.45 mg/kg who achieve less than 90% block (about 16% of these patients) may have a more rapid time to 25% recovery, 12 to 15 minutes. A large bolus dose of 0.9 or 1.2 mg/kg can be administered under opioid/nitrous oxide/oxygen anesthesia without adverse effects to the cardiovascular system [see Clinical Pharmacology ( 12.2 ) ].

2.3Rapid Sequence Intubation In appropriately premedicated and adequately anesthetized patients, rocuronium bromide 0.6 to 1.2 mg/kg will provide excellent or good intubating conditions in most patients in less than 2 minutes [see Clinical Studies ( 14.1 ) ].

2.4Maintenance Dosing Maintenance doses of 0.1, 0.15, and 0.2 mg/kg rocuronium bromide, administered at 25% recovery of control T1 (defined as 3 twitches of train-of-four), provide a median (range) of 12 (2 to 31), 17 (6 to 50), and 24 (7 to 69) minutes of clinical duration under opioid/nitrous oxide/oxygen anesthesia [see Clinical Pharmacology (12.2)]. In all cases, dosing should be guided based on the clinical duration following initial dose or prior maintenance dose and not administered until recovery of neuromuscular function is evident.

A clinically insignificant cumulation of effect with repetitive maintenance dosing has been observed [see Clinical Pharmacology ( 12.2 ) ].

2.5 Use by Cont…

💊 Dosage Forms and Strengths 61 words ▾

3 DOSAGE FORMS AND STRENGTHS Rocuronium bromide injection is available as • 50 mg/5 mL (10 mg/mL), multiple dose vials • 100 mg/10 ml (10 mg/mL), multiple dose vials 5 mL multiple dose vials containing 50 mg rocuronium bromide injection (10 mg/mL) ( 3 ) 10 mL multiple dose vials containing 100 mg rocuronium bromide injection (10 mg/mL) ( 3 )

⛔ Contraindications 43 words ▾

4 CONTRAINDICATIONS Rocuronium bromide is contraindicated in patients known to have hypersensitivity (e.g., anaphylaxis) to rocuronium bromide or other neuromuscular blocking agents [see Warnings and Precautions ( 5.2 )]. Hypersensitivity (e.g., anaphylaxis) to rocuronium bromide or other neuromuscular blocking agents. ( 4 )

⚠️ Warnings and Cautions ~3 min read ▾

5 WARNINGS AND PRECAUTIONS

5.1Appropriate Administration and Monitoring Rocuronium bromide should be administered in carefully adjusted dosages by or under the supervision of experienced clinicians who are familiar with the drug’s actions and the possible complications of its use. The drug should not be administered unless facilities for intubation, mechanical ventilation, oxygen therapy, and an antagonist are immediately available. It is recommended that clinicians administering neuromuscular blocking agents such as rocuronium bromide employ a peripheral nerve stimulator to monitor drug effect, need for additional doses, adequacy of spontaneous recovery or antagonism, and to decrease the complications of overdosage if additional doses are administered.

5.2Anaphylaxis Severe anaphylactic reactions to neuromuscular blocking agents, including rocuronium bromide, have been reported. These reactions have, in some cases (including cases with rocuronium bromide) been life threatening and fatal. Due to the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken.

Precautions should also be taken in those patients who have had previous anaphylactic reactions to other neuromuscular blocking agents, since cross-reactivity between neuromuscular blocking agents, both depolarizing and nondepolarizing, has been reported.

5.3Risk of Death due to Medication Errors Administration of rocuronium bromide injection results in paralysis, which may lead to respiratory arrest and death, a progression that may be more likely to occur in a patient for whom it is not intended. Confirm proper selection of intended product and avoid confusion with other injectable solutions that are present in critical care and other clinical settings. If another healthcare provider is administering the product, ensure that the intended dose is clearly labeled and communicated.

5.4Need for Adequate Anesthesia Rocuronium bromide has no known effect on consciousness, pain threshold, or cerebration. Therefore, its administration must be accompanied by adequate anesthesia or sedation.

5.5Residual Paralysis In order to prevent complications resulting from residual paralysis, it is recommended to extubate only after the patient has recovered sufficiently from neuromuscular block. Geriatric patients (65 years or older) may be at increased risk for residual neuromuscular block. Other factors which could cause residual paralysis after extubation in the post-operative phase (such as drug interactions or patient condition) should also be considered.

If not used as part of standard clinical practice the use of a reversal agent should be considered, especially in those cases where residual paralysis is more likely to occur.

5.6Long-Term Use in an Intensive Care Unit Rocuronium bromide has not been studied for long-term use in the intensive care unit (ICU). As with other nondepolarizing neuromuscular blocking drugs, apparent tolerance to rocuronium bromide may develop during chronic administration in the ICU. While the mechanism for development of this resistance is not known, receptor up-regulation may be a contributing factor.

It is strongly recommended that neuromuscular transmission be monitored continuously during administration and recovery with the help of a nerve stimulator. Additional doses of rocuronium bromide or any other neuromuscular blocking agent should not be given until there is a definite response (one twitch of the train-of-four) to nerve stimulation. Prolonged paralysis and/or skeletal muscle weakness may be noted during initial attempts to wean from the ventilator patients who have chronically received neuromuscular blocking drugs in the ICU.

Myopathy after long-term administration of other non-depolarizing neuromuscular blocking agents in the ICU alone or in combination with corticosteroid therapy has been reported. Therefore, for patients receiving both neuromus…

🤒 Adverse Reactions ~2 min read ▾

6 ADVERSE REACTIONS In clinical trials, the most common adverse reactions (2%) are transient hypotension and hypertension. The following adverse reactions are described, or described in greater detail, in other sections: · Anaphylaxis [see Warnings and Precautions ( 5.2 )] · Residual paralysis [see Warnings and Precautions ( 5.5 )] · Myopathy [see Warnings and Precautions ( 5.6 )] · Increased pulmonary vascular resistance [see Warnings and Precautions ( 5.12 )]

6.1Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Clinical studies in the U.S. (n=1137) and Europe (n=1394) totaled 2531 patients.

The patients exposed in the U.S. clinical studies provide the basis for calculation of adverse reaction rates. The following adverse reactions were reported in patients administered rocuronium bromide (all events judged by investigators during the clinical trials to have a possible causal relationship): Adverse reactions in greater than 1% of patients: None Adverse reactions in less than 1% of patients (probably related or relationship unknown): Cardiovascular: arrhythmia, abnormal electrocardiogram, tachycardia Digestive: nausea, vomiting Respiratory: asthma (bronchospasm, wheezing, or rhonchi), hiccup Skin and Appendages: rash, injection site edema, pruritus In the European studies, the most commonly reported reactions were transient hypotension (2%) and hypertension (2%); these are in greater frequency than the U.S. studies (0.1% and 0.1%).

Changes in heart rate and blood pressure were defined differently from in the U.S. studies in which changes in cardiovascular parameters were not considered as adverse events unless judged by the investigator as unexpected, clinically significant, or thought to be histamine related. In a clinical study in patients with clinically significant cardiovascular disease undergoing coronary artery bypass graft, hypertension and tachycardia were reported in some patients, but these occurrences were less frequent in patients receiving beta or calcium channel-blocking drugs.

In some patients, rocuronium bromide was associated with transient increases (30% or greater) in pulmonary vascular resistance. In another clinical study of patients undergoing abdominal aortic surgery, transient increases (30% or greater) in pulmonary vascular resistance were observed in about 24% of patients receiving rocuronium bromide 0.6 or 0.9 mg/kg. In pediatric patient studies worldwide (n=704), tachycardia occurred at an incidence of 5.3% (n=37) and it was judged by the investigator as related in 10 cases (1.4%).

6.2Post-Marketing Experience In clinical practice, there have been reports of severe allergic reactions (anaphylactic and anaphylactoid reactions and shock) with rocuronium bromide, including some that have been life threatening and fatal [see Warnings and Precautions ( 5.2 )] . Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency. Most common adverse reactions (2%) are transient hypotension and hypertension.

( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Piramal Critical Care at 1-888-822-8431 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

🔄 Drug Interactions ~3 min read ▾

7 DRUG INTERACTIONS

7.1Antibiotics Drugs which may enhance the neuromuscular blocking action of nondepolarizing agents such as rocuronium bromide include certain antibiotics (e.g., aminoglycosides; vancomycin; tetracyclines; bacitracin; polymyxins; colistin; and sodium colistimethate). If these antibiotics are used in conjunction with rocuronium bromide, prolongation of neuromuscular block may occur.

7.2Anticonvulsants In 2 of 4 patients receiving chronic anticonvulsant therapy, apparent resistance to the effects of rocuronium bromide was observed in the form of diminished magnitude of neuromuscular block, or shortened clinical duration. As with other nondepolarizing neuromuscular blocking drugs, if rocuronium bromide is administered to patients chronically receiving anticonvulsant agents such as carbamazepine or phenytoin, shorter durations of neuromuscular block may occur and infusion rates may be higher due to the development of resistance to nondepolarizing muscle relaxants.

While the mechanism for development of this resistance is not known, receptor up-regulation may be a contributing factor [see Warnings and Precautions ( 5.10 )] .

7.3Inhalation Anesthetics Use of inhalation anesthetics has been shown to enhance the activity of other neuromuscular blocking agents (enflurane > isoflurane > halothane). Isoflurane and enflurane may also prolong the duration of action of initial and maintenance doses of rocuronium bromide and decrease the average infusion requirement of rocuronium bromide by 40% compared to opioid/nitrous oxide/oxygen anesthesia. No definite interaction between rocuronium bromide and halothane has been demonstrated.

In one study, use of enflurane in 10 patients resulted in a 20% increase in mean clinical duration of the initial intubating dose, and a 37% increase in the duration of subsequent maintenance doses, when compared in the same study to 10 patients under opioid/nitrous oxide/oxygen anesthesia. The clinical duration of initial doses of rocuronium bromide of 0.57 to 0.85 mg/kg under enflurane or isoflurane anesthesia, as used clinically, was increased by 11% and 23%, respectively. The duration of maintenance doses was affected to a greater extent, increasing by 30% to 50% under either enflurane or isoflurane anesthesia.

Potentiation by these agents is also observed with respect to the infusion rates of rocuronium bromide required to maintain approximately 95% neuromuscular block. Under isoflurane and enflurane anesthesia, the infusion rates are decreased by approximately 40% compared to opioid/nitrous oxide/oxygen anesthesia. The median spontaneous recovery time (from 25% to 75% of control T 1 ) is not affected by halothane, but is prolonged by enflurane (15% longer) and isoflurane (62% longer).

Reversal-induced recovery of rocuronium bromide neuromuscular block is minimally affected by anesthetic technique [see Dosage and Administration ( 2.6 ) and Warnings and Precautions ( 5.10 )].

7.4Lithium Carbonate Lithium has been shown to increase the duration of neuromuscular block and decrease infusion requirements of neuromuscular blocking agents [see Warnings and Precautions ( 5.10 )].

7.5Local Anesthetics Local anesthetics have been shown to increase the duration of neuromuscular block and decrease infusion requirements of neuromuscular blocking agents [see Warnings and Precautions ( 5.10 )].

7.6Magnesium Magnesium salts administered for the management of toxemia of pregnancy may enhance neuromuscular blockade [see Warnings and Precautions ( 5.10 )].

7.7Nondepolarizing Muscle Relaxants There are no controlled studies documenting the use of rocuronium bromide before or after other nondepolarizing muscle relaxants. Interactions have been observed when other nondepolarizing muscle relaxants have been administered in succession.

7.8Procainamide Procainamide has been shown to increase the duration of neuromuscular block and decrease infusion requirements of neuromuscular blocking agents [see Warnings…

👥 Use in Specific Populations ~3 min read ▾

8 USE IN SPECIFIC POPULATIONS

8.1Pregnancy Developmental toxicology studies have been performed with rocuronium bromide in pregnant, conscious, nonventilated rabbits and rats. Inhibition of neuromuscular function was the endpoint for high-dose selection. The maximum tolerated dose served as the high dose and was administered intravenously 3 times a day to rats (0.3 mg/kg, 15% to 30% of human intubation dose of 0.6 to 1.2 mg/kg based on the body surface unit of mg/m2) from Day 6 to 17 and to rabbits (0.02 mg/kg, 25% human dose) from Day 6 to 18 of pregnancy.

High-dose treatment caused acute symptoms of respiratory dysfunction due to the pharmacological activity of the drug. Teratogenicity was not observed in these animal species. The incidence of late embryonic death was increased at the high dose in rats, most likely due to oxygen deficiency.

Therefore, this finding probably has no relevance for humans because immediate mechanical ventilation of the intubated patient will effectively prevent embryo-fetal hypoxia. However, there are no adequate and well-controlled studies in pregnant women. Rocuronium bromide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

8.2Labor and Delivery The use of rocuronium bromide in Cesarean section has been studied in a limited number of patients [see Clinical Studies ( 14.1 )]. Rocuronium bromide is not recommended for rapid sequence induction in Cesarean section patients.

8.4Pediatric Use The use of rocuronium bromide has been studied in pediatric patients 3 months to 14 years of age under halothane anesthesia. Of the pediatric patients anesthetized with halothane who did not receive atropine for induction, about 80% experienced a transient increase (30% or greater) in heart rate after intubation. One of the 19 infants anesthetized with halothane and fentanyl who received atropine for induction experienced this magnitude of change [see Dosage and Administration ( 2.6 ) and Clinical Studies ( 14.3 )].

Rocuronium bromide was also studied in pediatric patients up to 17 years of age, including neonates, under sevoflurane (induction) and isoflurane/nitrous oxide (maintenance) anesthesia. Onset time and clinical duration varied with dose, the age of the patient, and anesthetic technique. The overall analysis of ECG data in pediatric patients indicates that the concomitant use of rocuronium bromide with general anesthetic agents can prolong the QTc interval.

The data also suggest that rocuronium bromide may increase heart rate. However, it was not possible to conclusively identify an effect of rocuronium bromide independent of that of anesthesia and other factors. Additionally, when examining plasma levels of rocuronium bromide in correlation to QTc interval prolongation, no relationship was observed [see Dosage and Administration ( 2.6 ), Warnings and Precautions ( 5.9 ) and Clinical Studies ( 14.3 )].

Rocuronium bromide is not recommended for rapid sequence intubation in pediatric patients. Recommendations for use in pediatric patients are discussed in other sections [see Dosage and Administration ( 2.6 ) and Clinical Pharmacology ( 12.2 )].

8.5Geriatric Use Rocuronium bromide was administered to 140 geriatric patients (65 years or greater) in U.S. clinical trials and 128 geriatric patients in European clinical trials. The observed pharmacokinetic profile for geriatric patients (n=20) was similar to that for other adult surgical patients [see Clinical Pharmacology ( 12.3 )]. Onset time and duration of action were slightly longer for geriatric patients (n=43) in clinical trials.

Clinical experiences and recommendations for use in geriatric patients are discussed in other sections [see Dosage and Administration ( 2.6 ), Warnings and Precautions ( 5.5 ), Clinical Pharmacology ( 12.2 ), and Clinical Studies ( 14.2 )].

8.6Patients with Hepatic Impairment Since rocuronium bromide is primarily excreted by the liver, it should be used with caution i…

🆘 Overdosage 174 words ▾

10 OVERDOSAGE Overdosage with neuromuscular blocking agents may result in neuromuscular block beyond the time needed for surgery and anesthesia. The primary treatment is maintenance of a patent airway, controlled ventilation, and adequate sedation until recovery of normal neuromuscular function is assured. Once evidence of recovery from neuromuscular block is observed, further recovery may be facilitated by administration of an anticholinesterase agent in conjunction with an appropriate anticholinergic agent.

Reversal of Neuromuscular Blockade Anticholinesterase agents should not be administered prior to the demonstration of some spontaneous recovery from neuromuscular blockade. The use of a nerve stimulator to document recovery is recommended. Patients should be evaluated for adequate clinical evidence of neuromuscular recovery, e.g., 5-second head lift, adequate phonation, ventilation, and upper airway patency.

Ventilation must be supported while patients exhibit any signs of muscle weakness. Recovery may be delayed in the presence of debilitation, carcinomatosis, and concomitant use of certain drugs which enhance neuromuscular blockade or separately cause respiratory depression. Under such circumstances the management is the same as that of prolonged neuromuscular blockade.

🧬 Clinical Pharmacology ~3 min read ▾

12 CLINICAL PHARMACOLOGY

12.1Mechanism of Action Rocuronium bromide is a nondepolarizing neuromuscular blocking agent with a rapid to intermediate onset depending on dose and intermediate duration. It acts by competing for cholinergic receptors at the motor end-plate. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine and edrophonium.

12.2Pharmacodynamics The ED 95 (dose required to produce 95% suppression of the first [T 1 ] mechanomyographic [MMG] response of the adductor pollicis muscle [thumb] to indirect supramaximal train-of-four stimulation of the ulnar nerve) during opioid/nitrous oxide/oxygen anesthesia is approximately 0.3 mg/kg. Patient variability around the ED 95 dose suggests that 50% of patients will exhibit T 1 depression of 91% to 97%. Table 4 presents intubating conditions in patients with intubation initiated at 60 to 70 seconds.

Table 4. Percent of Excellent or Good Intubating Conditions and Median (Range) Time to Completion of Intubation in Patients with Intubation Initiated at 60 to 70 Seconds Rocuronium Bromide Dose (mg/kg) Administered over 5 sec Percent of Patients with Excellent or Good Intubating Conditions Time to Completion of Intubation (min) Adults* 18 to 64 yrs 0.45 (n=43) 0.6 (n=51) 86% 96% 1.6 (1.0-7.0) 1.6 (1.0-3.2) Infants† 3 mo to 1 yr 0.6 (n=18) 100% 1.0 (1.0-1.5) Pediatric† 1 to 12 yrs 0.6 (n=12) 100% 1.0 (0.5-2.3) * Excludes patients undergoing Cesarean section. † Pediatric patients were under halothane anesthesia.

Excellent intubating conditions = jaw relaxed, vocal cords apart and immobile, no diaphragmatic movement. Good intubating conditions = same as excellent but with some diaphragmatic movement. Table 5 presents the time to onset and clinical duration for the initial dose of rocuronium bromide injection under opioid/nitrous oxide/oxygen anesthesia in adults and geriatric patients, and under halothane anesthesia in pediatric patients.

Table 5. Median (Range) Time to Onset and Clinical Duration Following Initial (Intubating) Dose during Opioid/Nitrous Oxide/Oxygen Anesthesia (Adults) and Halothane Anesthesia (Pediatric Patients) Rocuronium Bromide Dose (mg/kg) Administered over 5 sec Time to ≥80% Block (min) Time to Maximum Block (min) Clinical Duration (min) Adults 18 to 64 yrs 0.45 (n=50) 0.6 (n=142) 0.9 (n=20) 1.2 (n=18) 1.3 (0.8-6.2) 1.0 (0.4-6.0) 1.1 (0.3-3.8) 0.7 (0.4-1.7) 3.0 (1.3-8.2) 1.8 (0.6-13.0) 1.4 (0.8-6.2) 1.0 (0.6-4.7) 22 (12-31) 31 (15-85) 58 (27-111) 67 (38-160) Geriatric > 65 yrs 0.6 (n=31) 0.9 (n=5) 1.2 (n=7) 2.3 (1.0-8.3) 2.0 (1.0-3.0) 1.0 (0.8-3.5) 3.7 (1.3-11.3) 2.5 (1.2-5.0) 1.3 (1.2-4.7) 46 (22-73) 62 (49-75) 94 (64-138) Infants 3 mo to 1 yr 0.6 (n=17) 0.8 (n=9) - - 0.8 (0.3-3.0) 0.7 (0.5-0.8) 41 (24-68) 40 (27-70) Pediatric 1 to 12 yrs 0.6 (n=27) 0.8 (n=18) 0.8 (0.4-2.0) - 1.0 (0.5-3.3) 0.5 (0.3-1.0) 26 (17-39) 30 (17-56) n=the number of patients who had time to maximum block recorded.

Clinical duration=time until return to 25% of control T 1 . Patients receiving doses of 0.45 mg/kg who achieved less than 90% block (16% of these patients) had about 12 to 15 minutes to 25% recovery. Table 6 presents the time to onset and clinical duration for the initial dose of rocuronium bromide injection under sevoflurane (induction) and isoflurane/nitrous oxide (maintenance) anesthesia in pediatric patients.

Table 6. Median (Range) Time to Onset and Clinical Duration Following Initial (Intubating) Dose During Sevoflurane (induction) and Isoflurane/Nitrous Oxide (maintenance) Anesthesia (Pediatric Patients) Rocuronium Bromide Dose (mg/kg) Administered over 5 sec Time to Maximum Block (min) Time to Reappearance T 3 (min) Neonates birth to <28 days 0.45 (n=5) 0.6 (n=10) 1 (n=6) 1.1 (0.6-2.2) 1.0 (0.2-2.1) 0.6 (0.3-1.8) 40.3 (32.5-62.6) 49.7 (16.6-119.0) 114.4 (92.6-136.3) Infants 28 days to ≤3 mo 0.45 (n=9) 0.6 (n=11) 1 (n=5) 0.5 (0.4-1.3) 0.4 (0.2-0.8) 0.3 (0.2-0.7) 49.1 (13.5-79.9) 59.8 (32.3-87.8) 103.3 (90.8-155.4) Toddlers >3 mo to ≤2…

📦 How Supplied / Storage and Handling 120 words ▾

16 HOW SUPPLIED/STORAGE AND HANDLING Rocuronium bromide injection is available in the following: 50 mg/5 mL (10 mg/mL) NDC 66794-228-41 multiple-dose vials of 5 mL in boxes of 10 100 mg/10 mL (10 mg/mL) NDC 66794-229-41 multiple-dose vials of 10 mL in boxes of 10 The packaging of this product contains no natural rubber (latex). Rocuronium bromide should be stored in a refrigerator, 2-8°C (36-46°F). DO NOT FREEZE.

Upon removal from refrigeration to room temperature storage conditions (25°C/77°F), use rocuronium bromide within 60 days. Use opened vials of rocuronium bromide within 30 days. Safety and Handling There is no specific work exposure limit for rocuronium bromide injection.

In case of eye contact, flush with water for at least 10 minutes.

📋 Description 121 words ▾

11 DESCRIPTION Rocuronium bromide injection is a nondepolarizing neuromuscular blocking agent with a rapid to intermediate onset depending on dose and intermediate duration. Rocuronium bromide is chemically designated as 1- [17β-(acetyloxy)-3α-hydroxy-2β-(4-morpholinyl)-5α-androstan-16β-yl]-1-(2-propenyl)pyrrolidinium bromide. The structural formula is: The chemical formula is C 32 H 53 BrN 2 O 4 with a molecular weight of 609.70.

The partition coefficient of rocuronium bromide in n-octanol/water is 0.5 at 20°C. Rocuronium bromide is supplied as a sterile, nonpyrogenic, isotonic solution that is clear, colorless to yellow/orange, for intravenous injection only. Each mL contains 10 mg rocuronium bromide and 2 mg sodium acetate.

The aqueous solution is adjusted to isotonicity with sodium chloride and to a pH of 4 with acetic acid and/or sodium hydroxide. structure

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗

Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for this package alone, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q1 2026 · 5 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
617
Units reimbursed last 4 qtrs
2K
Gross reimbursed last 4 qtrs
$33K
Avg / prescription
$53.48
Avg / unit
$16.2373
Latest quarter Q1 2026
337Rx
Medicaid pays / mL
$16.2373
gross reimbursed
vs
NADAC / mL
$0.3942
acquisition cost
=
Spread
+$15.8431
+4019% vs cost
What Medicaid paid per mL (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care ⓘ
97% MCO
Fee-for-service · 19 Rx Managed care · 598 Rx
State Medicaid map
Alaska: no data reported AK Maine: no data reported ME Washington: no data reported WA Idaho: no data reported ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: no data reported MN Wisconsin: no data reported WI Michigan: no data reported MI New York: no data reported NY Vermont: no data reported VT New Hampshire: no data reported NH Oregon: no data reported OR Nevada: no data reported NV Wyoming: no data reported WY South Dakota: no data reported SD Iowa: no data reported IA Illinois: no data reported IL Indiana: no data reported IN Ohio: 13 units · 0.1 per 100k residents OH Pennsylvania: 173 units · 1.3 per 100k residents PA New Jersey: no data reported NJ Massachusetts: no data reported MA California: 53 units · 0.1 per 100k residents CA Utah: no data reported UT Colorado: no data reported CO Nebraska: no data reported NE Missouri: no data reported MO Kentucky: 16 units · 0.4 per 100k residents KY West Virginia: no data reported WV Virginia: no data reported VA Maryland: 55 units · 0.9 per 100k residents MD Connecticut: no data reported CT Rhode Island: no data reported RI Arizona: no data reported AZ New Mexico: 112 units · 5.3 per 100k residents NM Kansas: no data reported KS Arkansas: no data reported AR Tennessee: 1,169 units · 16.4 per 100k residents TN North Carolina: no data reported NC South Carolina: no data reported SC Delaware: no data reported DE Oklahoma: no data reported OK Louisiana: no data reported LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: no data reported GA D.C.: 441 units · 64.9 per 100k residents DC Hawaii: no data reported HI Texas: no data reported TX Florida: no data reported FL
Units reimbursed · per 100k residents
0.164.9
gray = no data reported ⓘ
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 D.C. 64.9 /100k
2 Tennessee 16.4 /100k
3 New Mexico 5.3 /100k
4 Pennsylvania 1.3 /100k
5 Maryland 0.9 /100k
6 Kentucky 0.4 /100k
7 California 0.1 /100k
8 Ohio 0.1 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Rocuronium — the ingredient across all brands.

Top reported reactions

Anaphylactic Reaction1,279
Hypotension1,124
Anaphylactic Shock1,004
Cardiac Arrest662
Drug Interaction466
Tachycardia428
Bradycardia397

Age at onset

Neonate138
Infant55
Child316
Adolescent52
Adult1,079
Elderly481

Reporter sex

11,714 reports
Male · 49%
Female · 51%
Unknown · 1%

Serious outcomes

Hospitalization4,263
Life-threatening3,426
Death938
Disabling217
Reports over time (by year) — tap or hover for the count & year
2019 2021 2023 2026 1,136 851
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.
← 66794-0219-43 · Piramal 66794-0229-41 · Piramal →
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.