Avoid Mix-Ups with New Room Temperature Rocuronium

Top Takeaways

• Room temperature rocuronium comes as a 5 mL and 10 mL vial, as well as a prefilled glass syringe.
• For now, expect to see refrigerated AND room temperature rocuronium on the market.
• Alert the pharmacist if room temperature rocuronium accidentally gets placed in the fridge to assess if it’s still usable.

You’ll hear talk about adding new room temperature stable (RTS) rocuronium to your hospital’s formulary.

Rocuronium is used in surgery or emergent situations to relax breathing muscles for intubation. For years, it has required refrigeration...but gets a 60-day BUD at room temp.

Now there’s a new formulation that is ONLY stored at room temp...and has an expiration date of 2 years.

Reps will tout its simplified storage requirements that eliminate the “cold chain,” free up refrigerator space, and ideally reduce costs.

For now, expect to see refrigerated AND room temperature products on the market. Stay alert for mix-ups during receiving, dispensing, etc...since rocuronium errors can be harmful or deadly.

Scan barcodes to verify the correct product. For example, RTS and refrigerated rocuronium both come in similar 50 mg/5 mL and 100 mg/10 mL vials. Plus it comes as an RTS 50 mg/5 mL prefilled glass syringe.

Be aware, the RTS syringe contains a red label, similar to certain succinylcholine syringes...and may also be confused with other look-alike syringe products (push-dose pressors, etc). Help choose manufacturers with different colored labels if possible.

Apply aux stickers (“Paralyzing agent,” etc) to the vials or syringes AND pharmacy storage bins.

Continue to stock ALL paralytics in locked-lidded pockets or sealed rapid sequence intubation (RSI) kits in the ED, ICU, etc.

Work with pharmacy leadership to create a plan if you need to alternate between RTS and refrigerated rocuronium during a shortage.

Alert a pharmacist if RTS rocuronium accidentally gets placed in the fridge so they can assess if it’s still usable. Excursions are permitted between 59°F to 86°F (15°C to 30°C)...but do NOT freeze the product.

Keep in mind, RTS rocuronium vials cost around the same as the refrigerated product (under $10 per 5 mL vial)...versus about $15 per RTS 50 mg/5 mL syringe. Some hospitals report significant cost and waste savings with RTS rocuronium.

On the other hand, facilities with high usage may see less benefit, since they expire less product due to rocuronium’s 60-day BUD once removed from the fridge (or 30 days for punctured multidose vials).