Sugammadex and Contraception

Introduction to Sugammadex and Contraception

The American Society of Anesthesiologists notes that sugammadex can be safely used in patients with IUDs without concern for contraceptive failure, but patients taking oral hormonal contraceptives must follow "missed pill rules" after sugammadex administration 1

Sugammadex does not affect the effectiveness of intrauterine devices (IUDs) because they work through local mechanisms, such as copper toxicity to sperm or local progestin effects, rather than systemic hormonal pathways 1
Oral contraceptives are affected by sugammadex because it can bind to progestins in the circulation, potentially reducing their effectiveness 1

For patients with IUDs, no special precautions are needed, and standard dosing of sugammadex applies, with 2 mg/kg for moderate blockade or 4 mg/kg for deep blockade 1, 2
For patients on oral contraceptives, counseling to follow "missed pill rules" after sugammadex administration is necessary, which typically means using backup contraception for 7 days 1

Sugammadex is a modified gamma-cyclodextrin that encapsulates steroidal neuromuscular blocking agents, such as rocuronium and vecuronium, and can also bind to steroid hormones like progestins found in oral contraceptives 1, 3
IUDs release hormones locally in the uterus or work through non-hormonal mechanisms, resulting in minimal systemic hormone levels compared to oral contraceptives, and sugammadex's large molecular size and high polarity limit its distribution 1