Long-term Use in ICU ZEMURON® (rocuronium bromide) Injection has not been studied for long-term use in the ICU. As with other nondepolarizing neuromuscular blocking drugs, apparent tolerance to ZEMURON® may develop rarely 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 ZEMURON® 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. Therefore, ZEMURON® should only be used in this setting if, in the opinion of the prescribing physician, the specific advantages of the drug outweigh the risk.
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