Case study and discussion: Sugammadex in pregnant patients undergoing non-obstetric surgery and non-pregnant patients taking hormonal contraceptives

Sugammadex is a modified gamma-cyclodextrin used to reverse neuromuscular blockade caused by rocuronium. It binds, encapsulates, and deactivates rocuronium to achieve this effect and is later renally excreted. The molecular structure of rocuronium and progesterone are similar enough that pharmokinetic modelling suggests sugammadex will also bind, encapsulate and deactivate progesterone, resulting in a drop in plasma concentration of approximately 34%[1].

A decrease in serum progesterone can lead to failure of hormonal contraceptives, along with pre-term labour / miscarriage [2].