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Sugammadex Dose Calculator
Enter the patient's weight to get the sugammadex dose for the depth of block, with neostigmine and glycopyrronium and the rocuronium doses they reverse. Sugammadex is dosed on actual body weight, including in obesity, as in the product licence. Choose the dose from neuromuscular monitoring; 16 mg/kg is only for immediate reversal after rocuronium 1.2 mg/kg in adults, and sugammadex is not recommended in severe renal impairment.
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Neuromuscular block
Relaxants and reversal.
Worked example
What this calculator shows for a typical patient. Change the values above for yours.
| Moderate block, T2 | 140 mg |
|---|---|
| Deep block, PTC 1–2 | 280 mg |
| Immediate reversal | 1120 mg |
| Moderate block, T2 | 260 mg |
|---|---|
| Deep block, PTC 1–2 | 520 mg |
| Immediate reversal | 2080 mg |
Frequently asked questions
Which body weight is used for sugammadex in obesity?
Actual (total) body weight, as in the product licence (SmPC). The 2015 Association of Anaesthetists guideline suggested adjusted body weight; the calculator follows the licence, because underdosing risks residual block.
Can sugammadex reverse atracurium or cisatracurium?
No. Sugammadex binds aminosteroid relaxants, mainly rocuronium and, less strongly, vecuronium. Atracurium and cisatracurium are reversed with neostigmine once there is enough spontaneous recovery, guided by monitoring, or allowed to recover spontaneously.
What is the dose of neostigmine for reversal?
50 micrograms/kg, up to 2.5 mg in children and 5 mg in adults, with glycopyrronium 10 micrograms/kg (up to 500 micrograms). Neostigmine works best at minimal block: give it once all four twitches are present, ideally with a train-of-four ratio of at least 0.4 on a quantitative monitor, and confirm a ratio of at least 0.9 before extubation (ASA 2023).
How many mL of sugammadex is a dose?
Sugammadex contains 100 mg/mL, in 2 mL (200 mg) and 5 mL (500 mg) vials, so the volume in mL is the dose in mg divided by 100. For example, 4 mg/kg for a 70 kg patient is 280 mg, or 2.8 mL. If you dilute it, for example for a small child, work out the volume from the diluted concentration.
Formulas & sources
How each value is calculated. Tap next to an item to jump here.
Neuromuscular block
Rocuronium
Back to dose ↑Intubation 0.6 mg/kg; rapid sequence 1–1.2 mg/kg. Reversible with sugammadex. Obesity: lean body weight (Association of Anaesthetists 2015).
Related terms: Esmeron
Sugammadex
Back to dose ↑2 mg/kg when T2 has reappeared, 4 mg/kg at 1–2 post-tetanic counts, and 16 mg/kg for immediate reversal after rocuronium 1.2 mg/kg (adults; not investigated in children). Base the dose on neuromuscular monitoring.
Obesity: actual body weight, as in the product licence (SmPC). This replaces the adjusted body weight of the 2015 Association of Anaesthetists guideline.
Not recommended in severe renal impairment (SmPC).
Related terms: Bridion, reversal
Neostigmine
Back to dose ↑50 µg/kg (maximum 2.5 mg in children and 5 mg in adults) with glycopyrronium 10 µg/kg (maximum 500 µg). It works best at minimal block: give it once all four twitches are present, ideally with a train-of-four ratio of at least 0.4 on a quantitative monitor, and confirm a ratio of at least 0.9 before extubation (ASA 2023; ESAIC 2023 allows from a ratio above 0.2).
Related terms: reversal, anticholinesterase
Main sources
- BNF and BNF for Children (NICE), current editions.
- Association of Paediatric Anaesthetists (APA) and Advanced Paediatric Life Support (APLS).
- Resuscitation Council UK, 2025 Guidelines (paediatric and adult life support) and 2021 anaphylaxis guidance.
- Association of Anaesthetists: peri-operative management of the obese surgical patient (2015), Quick Reference Handbook (local anaesthetic toxicity 3-10, malignant hyperthermia 3-8); European MH Group (2024).
- British Society for Haematology (BSH) transfusion guidelines, NICE CG174 (intravenous fluids) and product licences (SmPC, emc).
For education only. These figures support, but do not replace, clinical judgement, local protocols and the current BNF/BNFc and product literature. Check every dose before giving it and titrate to effect. See also the disclaimer.