Summary of Use during Lactation

Negligible amounts of sugammadex are excreted into breastmilk after usual doses. Because sugammadex is a large, highly polar molecule with a molecular weight of 2002 Da, oral absorption by the infant is unlikely. Sugammadex is acceptable to use during breastfeeding.[1-3]

Drug Levels

Maternal Levels. Women undergoing cesarean section who received general anesthesia and neuromuscular block with rocuronium donated breastmilk samples at one (n = 8) and six (n = 8) hours following sugammadex administration in a median dose of 2.56 mg/kg. All patients received a 200 mg dose, and one received an additional 200 mg dose in the PACU. Of the eight 1-hour samples, sugammadex was undetectable in seven breastmilk samples and unquantifiable (<1 mg/L) in one sample. Of the eight samples obtained at 6 hours, sugammadex was undetectable in seven breastmilk samples and unquantifiable (<1 mg/L) in one (12.5%) sample.[4]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

A study compared sugammadex to neostigmine in their effects on lactation-related hormones in women undergoing cesarean section surgery under general anesthesia. Both groups showed significant decreases in progesterone and estradiol levels after surgery compared to preoperative values; however, the sugammadex group exhibited a significantly greater decrease. Aldosterone levels reached their highest point at the end of surgery, but by 4 hours later they were lower than before surgery, especially in the sugammadex group. Cortisol showed a temporary postoperative elevation, whereas prolactin and oxytocin levels rose in both groups, with no significant intergroup variations.[5]

Alternate Drugs to Consider

Neostigmine

References

1.

Reece-Stremtan S, Campos M, Kokajko L, et al. ABM Clinical Protocol #15: Analgesia and anesthesia for the breastfeeding mother, revised 2017. Breastfeed Med 2017;12:500–6. [PubMed: 29624435]

2.

Richardson MG, Raymond BL. Sugammadex administration in pregnant women and in women of reproductive potential: A narrative review. Anesth Analg 2020;130:1628–37. [PubMed: 31283616]

3.

Hirsch JG, Chia PA, Jahr JS. Sugammadex: A review of the considerations for women of childbearing age. Am J Ther 2023;30:e146–e50. [PubMed: 36892560]

4.

Hodge AT, Tognolini AR, Liu X, et al. Plasma levels and postpartum breastmilk concentrations of sugammadex: A pharmacokinetic study in women undergoing general anaesthesia for caesarean delivery. Int J Obstet Anesth 2026;66:104874. [PubMed: 41747364]

5.

Akça Ş, Karayol Akın A, Özdemir F, et al. Effects of sugammadex and neostigmine on maternal steroid and lactation-related hormone levels during cesarean section: A randomized clinical trial. J Clin Pract Res 2025;47:615–21. doi:10.14744/cpr.2025.59421 [CrossRef]

Substance Name

Sugammadex

CAS Registry Number

343306-71-8

Drug Class

Breast Feeding

Lactation

Milk, Human

Antidotes

Gamma-Cyclodextrins

Neuromuscular Blockade