Succinylcholine (Suxamethonium)

Pharmacologic Category

Neuromuscular Blocker Agent, Depolarizing

Dosing: Adult

Note: Dose to effect; doses will vary due to interpatient variability. Ensure adequate pain control and sedation prior to and during administration of neuromuscular blockade. Use carefully and/or consider dose reduction in patients with reduced plasma cholinesterase activity due to genetic abnormalities of plasma cholinesterase or when associated with other conditions (eg, electrolyte abnormalities, neuromuscular disease); prolonged neuromuscular blockade may occur.

Electroconvulsive therapy (ECT), muscle relaxation (off-label use): IV: 0.5 to 1.5 mg/kg (doses ≥0.75 mg/kg are more common in clinical practice); adjust dose higher or lower based on muscle mass, muscle relaxation with previous ECT, and patient-specific risks associated with suboptimal relaxation (eg, increase dose in patients with osteoporosis) (Ding 2002; Mirzakhani 2016; Murali 1999). Note: Most patients will recover respiratory function and muscle strength within 9 to 10 minutes (Mirzakhani 2016; Murali 1999).

Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation (as adjunct to general anesthesia):

IM: Up to 3 to 4 mg/kg, maximum total dose: 150 mg.

IV:

Intubation: 0.6 mg/kg (range: 0.3 to 1.1 mg/kg).

Rapid-sequence intubation (off-label dosing): 1 to 1.5 mg/kg (Sluga 2005; Weiss 1997).

Long surgical procedures (intermittent administration): Initial: 0.3 to 1.1 mg/kg; administer 0.04 to 0.07 mg/kg at appropriate intervals as needed.

Note: Pretreatment with atropine may reduce occurrence of bradycardia. Initial dose of succinylcholine must be increased when nondepolarizing agent pretreatment is used because of the antagonism between succinylcholine and nondepolarizing neuromuscular-blocking agents (Miller 2010). When the cumulative dose of succinylcholine exceeds 2 to 4 mg/kg under general anesthesia, transition from a phase I to a phase II block may occur. If phase II block is suspected, diagnosis should be confirmed by peripheral nerve stimulation prior to administration of an anticholinesterase drug (Hilgenberg 1981).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Obesity: Adult

Use total body weight for obese patients (Bentley 1982; Brunette 2004; Rose 2000).

Dosing: Pediatric

Note: Dose to effect; doses will vary due to interpatient variability. Use carefully and/or consider dose reduction in patients with reduced plasma cholinesterase activity due to genetic abnormalities of plasma cholinesterase or when associated with other conditions (eg, electrolyte abnormalities, neuromuscular disease); prolonged neuromuscular blockade may occur. Initial dose of succinylcholine must be increased when nondepolarizing agent pretreatment used because of the antagonism between succinylcholine and nondepolarizing neuromuscular-blocking agents (Miller 2010). Because of the risk of adverse effects including malignant hyperthermia and cardiac arrhythmias, surgical or long-term paralytic use (ie, continuous IV infusion) is not recommended (Coté 2013; Fisher 1999).

Endotracheal intubation; emergent (eg, rapid sequence intubation): Note: To reduce the risk of bradycardia or asystole, premedication with atropine recommended prior to IV succinylcholine doses (AAP [Hegenbarth 2008]; Coté 2013)

Infants, Children, and Adolescents: Note: In obese patients, pediatric patient data (age range: 9 to 15 years) suggest dosing based on use total body weight (Rose 2000).

IM:

Infants <6 months: Limited data available: 4 to 5 mg/kg; pharmacokinetic data suggests that young infants typically require doses on the higher end of this range (AAP [Hegenbarth 2008]; Coté 2013)

Infants ≥6 months and Children: 4 mg/kg; maximum dose: 150 mg/dose (AAP [Hegenbarth 2008]; Lui 1981)

Adolescents: 3 to 4 mg/kg; maximum dose: 150 mg/dose

IV:

Manufacturer's labeling:

Infants ≤6 months: 2 to 3 mg/kg/dose

Infants >6 months and Children ≤2 years: 1 to 2 mg/kg/dose

Children >2 years and Adolescents: 1 mg/kg/dose

Alternate dosing: Limited data available:

Infants: 2 to 3 mg/kg/dose (AAP [Hegenbarth 2008]; Coté 2013)

Children: 1 to 2 mg/kg/dose (AAP [Hegenbarth 2008]; Ballow 2012; Coté 2013)

Adolescents: 1 to 1.5 mg/kg/dose (Ballow 2012; Sluga 2005; Weiss 1997)

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Use: Labeled Indications

Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation: As an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation in adequately sedated patients

Note: Neuromuscular blockade does not provide pain control, sedation, or amnestic effects. Appropriate analgesic and sedative mediations should be used before and during administration of neuromuscular blockade to achieve deep sedation.

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

Electroconvulsive therapy, muscle relaxationLevel of Evidence [C]

Data from a limited number of patients studied suggest that succinylcholine may be beneficial to minimize muscle contractions during electroconvulsive therapy Ref.

Level of Evidence Definitions

Level of Evidence Scale

Use: Unsupported: Adult

Neuromuscular blockade as continuous infusion for surgical procedures

Although included as an FDA-approved use in the manufacturer's labeling for use as a continuous infusion for long surgical procedures, clinically, the use of succinylcholine for this indication has fallen out of favor and is no longer routinely used due to the introduction of newer neuromuscular blocking agents, less invasive surgical techniques, and side effects (including risk of block becoming phase II block) (expert opinion).

Clinical Practice Guidelines

Critical Care:

ACCM/SCCM/ASHP, “Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient,” January 2002

SCCM, “Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient,” 2016

Administration: IM

Administer deep IM only when IV access is not available.

Administration: IV

May be administered undiluted by rapid IV injection.

Administration: Injectable Detail

pH: 3 to 4.5

Administration: Pediatric

Parenteral:

IM: Injection should be made deeply. Use only when IV access is not available.

IV: May be administered undiluted by rapid IV injection.

Storage/Stability

Manufacturer recommends refrigeration at 2°C to 8°C (36°F to 46°F) and may be stored at room temperature for 14 days; however, additional testing has demonstrated stability for ≤6 months unrefrigerated (25°C) (Ross, 1988; Roy, 2008). Stability in polypropylene syringes (20 mg/mL) at room temperature (25°C) is 45 days (Storms, 2003).

Compatibility

See Trissel’s IV Compatibility Database

Open Trissel's IV Compatibility

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to calm muscles during surgery.

• It is used to calm muscles while on a breathing machine.

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Slow heartbeat

• Severe dizziness

• Passing out

• Severe headache

• Vision changes

• Muscle pain

• Muscle weakness

• Dark urine

• Twitching

• Unable to pass urine

• Eye pain

• Chest pain

• High potassium like abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, or numbness or tingling feeling.

• Malignant hyperthermia like fast heartbeat, fast breathing, fever, spasm of jaw muscles, or stiffness of jaw muscles.

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

High alert medication:

Other safety concerns:

International issues:

Contraindications

Hypersensitivity to succinylcholine or any component of the formulation; personal or familial history of malignant hyperthermia; skeletal muscle myopathies; use after the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury.

Documentation of allergenic cross-reactivity for neuromuscular blockers is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: Severe anaphylactic reactions (some life-threatening and fatal) have been reported; immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during use. Use caution in patients with previous anaphylactic reactions to other neuromuscular blocking agents.

• Bradycardia: Risk of bradycardia may be increased with second dose and may occur more in children. Occurrence may be reduced by pretreating with anticholinergic agents (eg, atropine).

• Increased intraocular pressure (IOP): May increase IOP; avoid use in patients in which an increase in IOP is undesirable (eg, narrow-angle glaucoma, penetrating eye injuries).

• Intracranial pressure: May cause a transient increase in intracranial pressure (adequate anesthetic induction prior to administration of succinylcholine will minimize this effect).

• Intragastric pressure: May increase intragastric pressure, which could result in regurgitation and possible aspiration of stomach contents.

• Malignant hyperthermia: Use may be associated with acute onset of malignant hyperthermia; risk may be increased with concomitant administration of volatile anesthetics.

• Neuromuscular cross-sensitivity: Cross-sensitivity with other neuromuscular-blocking agents may occur; use extreme caution in patients with previous anaphylactic reactions to other neuromuscular-blocking agents.

• Vagal tone: May increase vagal tone.

Disease-related concerns:

• Burn injury: Use with caution in patients with extensive or severe burns; risk of hyperkalemia is increased following injury. Onset of time and duration of risk are variable, but risk is generally greatest 7 to 10 days after injury. Resistance may occur in burn patients (≥20% of total body surface area), usually several days after the injury, and may persist for several months after wound healing (Han 2009).

• Conditions that may antagonize neuromuscular blockade (decreased paralysis): Respiratory alkalosis, hypercalcemia, demyelinating lesions, peripheral neuropathies, denervation, muscle trauma, and diabetes mellitus may result in antagonism of neuromuscular blockade (ACCM/SCCM/ASHP [Murray 2002]; Greenberg 2013; Miller 2010; Naguib 2002).

• Conditions that may potentiate neuromuscular blockade (increased paralysis): Electrolyte abnormalities (eg, severe hypocalcemia, severe hypokalemia, hypermagnesemia), neuromuscular diseases, metabolic acidosis, respiratory acidosis, Eaton-Lambert syndrome, and myasthenia gravis may result in potentiation of neuromuscular blockade (Greenberg 2013; Miller 2010; Naguib 2002).

• Fractures/muscle spasm: Use with caution in patients with fractures or muscle spasm; initial muscle fasciculations may cause additional trauma.

• Hyperkalemia: Use with extreme caution in patients with pre-existing hyperkalemia. Severe hyperkalemia may develop in patients with chronic abdominal infections, burn injuries, multiple trauma/crush injuries, extensive denervation of skeletal muscle, upper motor neuron injury, subarachnoid hemorrhage, or conditions which cause degeneration of the central and peripheral nervous system.

• Plasma pseudocholinesterase disorders: Metabolized by plasma cholinesterase; use with caution (if at all) in patients suspected of being homozygous for the atypical plasma cholinesterase gene. Plasma cholinesterase activity may also be reduced by burns, anemia, decompensated heart disease, infections, malignant tumors, myxedema, pregnancy, severe hepatic or renal dysfunction, peptic ulcer, and certain medications and chemicals.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Elderly: Use with caution in the elderly, effects and duration are more variable.

• Pediatric: [US Boxed Warning]: Use caution in children and adolescents. Acute rhabdomyolysis with hyperkalemia, ventricular arrhythmias and cardiac arrest have been reported (rarely) in children with undiagnosed skeletal muscle myopathy (eg, Duchenne muscular dystrophy); occurs soon after administration and requires immediate treatment of hyperkalemia. Prolonged resuscitation may be required. Use in children should be reserved for emergency intubation when immediate airway control is necessary (eg, laryngospasm, difficult airway, full stomach), or IM use when a suitable vein is inaccessible.

Other warnings/precautions:

• Appropriate use: Maintenance of an adequate airway and respiratory support is critical. All patients should receive eye care including liberal use of lubricating drops, gel, or ointment and eyelids should remain closed during continuous neuromuscular blockade to protect against damage to the cornea (ulceration and dryness).

• Experienced personnel: Should be administered by adequately trained individuals familiar with its use.

• Risk of medication errors: Accidental administration may be fatal. Confirm proper selection of intended product, store vial so the cap and ferrule are intact and the possibility of selecting the wrong product is minimized, and ensure that the intended dose is clearly labeled and communicated, when applicable.

* See Cautions in AHFS Essentials for additional information.

Warnings: Additional Pediatric Considerations

In children and adolescents, rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death have been reported in children with undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy. This syndrome presents as peaked T-waves and sudden cardiac arrest within minutes after the administration of succinylcholine. Bradycardia and rarely asystole have been reported; higher incidence in children, particularly those receiving doses >1.5 mg/kg, and following repeat dosing in both children and adults. Also, if sudden cardiac arrest occurs immediately after administration of succinylcholine, consider hyperkalemia as potential etiology and manage accordingly. In neonates, some experts consider hyperkalemia a contraindication for use (AAP [Kumar 2010]).

Reproductive Considerations

Sensitivity to succinylcholine may be increased due to a decrease in plasma cholinesterase activity in patients taking chronic oral contraceptives.

Pregnancy Considerations

Small amounts cross the placenta. Sensitivity to succinylcholine may be increased due to a ~24% decrease in plasma cholinesterase activity during pregnancy and several days postpartum; prolonged maternal apnea may be observed. Newborns of mothers with atypical plasma cholinesterase or those exposed to repeated or high doses of succinylcholine during cesarean delivery should be monitored for apnea and flaccidity.

Breast-Feeding Considerations

It is not known if succinylcholine is present in breast milk. The manufacturer recommends that caution be exercised when administering succinylcholine to breastfeeding women.

Briggs' Drugs in Pregnancy & Lactation

• Succinylcholine

Adverse Reactions

Frequency not defined.

Cardiovascular: Bradycardia (higher with second dose; more frequent in children), cardiac arrhythmia, hypertension, hypotension, malignant hyperthermia, tachycardia

Dermatologic: Skin rash

Endocrine & metabolic: Hyperkalemia

Gastrointestinal: Sialorrhea

Hypersensitivity: Anaphylaxis

Neuromuscular & skeletal: Fasciculations, jaw tightness, myalgia (postoperative), rhabdomyolysis (with possible myoglobinuric acute renal failure)

Ophthalmic: Increased intraocular pressure

Respiratory: Apnea, respiratory depression (prolonged)

<1%, postmarketing, and/or case reports: Abnormal bone growth (myositis ossificans; prolonged use), myopathy (acute quadriplegic myopathy syndrome; prolonged use)

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Neuromuscular-Blocking Agent Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Acetylcholinesterase Inhibitors: May increase the serum concentration of Succinylcholine. Management: Consider alternatives to this combination due to a risk of prolonged neuromuscular blockade. Risk D: Consider therapy modification

Aminoglycosides: May enhance the therapeutic effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bacitracin (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bambuterol: May enhance the therapeutic effect of Succinylcholine. Bambuterol may increase the serum concentration of Succinylcholine. Risk C: Monitor therapy

Botulinum Toxin-Containing Products: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Bromperidol: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Cardiac Glycosides: Neuromuscular-Blocking Agents may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy

Clindamycin (Topical): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Colistimethate: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of these products. Monitor for deeper, prolonged neuromuscular-blocking effects (respiratory paralysis) in patients receiving concomitant neuromuscular-blocking agents and colistimethate. Risk D: Consider therapy modification

Cyclophosphamide: May increase the serum concentration of Succinylcholine. Management: Consider alternatives to succinylcholine in patients who have received cyclophosphamide in the past 10 days, or reduced succinylcholine doses (a serum pseudocholinesterase assay may help inform this reduction) with close monitoring. Risk D: Consider therapy modification

CycloSPORINE (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Echothiophate Iodide: May increase the serum concentration of Succinylcholine. Management: For patients receiving echothiophate iodide eye drops, consider using a neuromuscular-blocking agents other than succinylcholine. If succinylcholine is used, consider a reduced dose, and monitor for enhanced/prolonged effects. Risk D: Consider therapy modification

Esmolol: May enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Estrogen Derivatives: May increase the serum concentration of Succinylcholine. Risk C: Monitor therapy

Lincosamide Antibiotics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Lithium: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Local Anesthetics: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Exceptions: Benzocaine; Benzydamine; Cocaine (Topical); Dibucaine; Dyclonine; Ethyl Chloride; Hexylresorcinol; Lidocaine (Ophthalmic); Lidocaine (Topical); Pramoxine; Proparacaine; Tetracaine (Ophthalmic); Tetracaine (Topical). Risk C: Monitor therapy

Loop Diuretics: May diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Magnesium Salts: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Metoclopramide: May enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Opioid Agonists: Succinylcholine may enhance the bradycardic effect of Opioid Agonists. Risk C: Monitor therapy

Phenelzine: May enhance the neuromuscular-blocking effect of Succinylcholine. Management: Consider a lower initial succinylcholine dose in patients taking phenelzine, or those who have taken phenelzine within the previous 2 weeks. Monitor for increased succinylcholine effects (eg, prolonged apnea) in patients who recently received phenelzine. Risk D: Consider therapy modification

Pholcodine: May enhance the adverse/toxic effect of Neuromuscular-Blocking Agents. Specifically, anaphylaxis has been reported. Risk C: Monitor therapy

Polymyxin B: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of neuromuscular-blocking agents and polymyxin B. If concomitant use cannot be avoided, monitor for deeper, prolonged neuromuscular-blocking effects (eg, respiratory paralysis) in patients receiving this combination. Risk D: Consider therapy modification

Procainamide: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

QuiNIDine: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

QuiNINE: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk X: Avoid combination

Sertraline: May increase the serum concentration of Succinylcholine. Risk C: Monitor therapy

Tetracyclines: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Vancomycin: May enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Gene Testing May Be Considered

• CACNA1S - Succinylcholine
• RYR1 - Succinylcholine

Genes of Interest

• BChE - Succinylcholine

Monitoring Parameters

Vital signs (heart rate, blood pressure, respiratory rate); degree of muscle paralysis (eg, presence of spontaneous movement, ventilator asynchrony, shivering, and consider use of a peripheral nerve stimulator with train of four monitoring along with clinical assessments); serum potassium and calcium

In the ICU setting, prolonged paralysis and generalized myopathy, following discontinuation of agent, may be minimized by appropriately monitoring degree of blockade.

Advanced Practitioners Physical Assessment/Monitoring

Continuous monitoring of vital signs, cardiac status, respiratory status, and degree of neuromuscular block (objective assessment with external nerve stimulator) is mandatory during infusion and until full muscle tone has returned. Safety precautions regarding ventilation must be maintained until full muscle tone has returned. Ventilatory support must be instituted and maintained until adequate respiratory muscle function and/or airway protection are assured. Obtain temperature, serum potassium, and serum calcium.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities. Ventilatory support must be instituted and maintained until adequate respiratory muscle function and/or airway protection are assured. Continuous monitoring of vital signs, cardiac status, respiratory status, and degree of neuromuscular block (objective assessment with external nerve stimulator) is mandatory during infusion and until full muscle tone has returned. Safety precautions regarding ventilation must be maintained until full muscle tone has returned.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Injection, as chloride:

Anectine: 20 mg/mL (10 mL) [contains methylparaben]

Quelicin: 20 mg/mL (10 mL) [contains methylparaben, propylparaben]

Generic: 20 mg/mL (10 mL)

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection, as chloride:

Quelicin Chloride: 20 mg/mL (10 mL, 20 mL); 100 mg/mL ([DSC])

Generic: 20 mg/mL (5 mL, 10 mL, 20 mL)

Anatomic Therapeutic Chemical (ATC) Classification

• M03AB01

Generic Available (US)

Yes

Pricing: US

Solution (Anectine Injection)

20 mg/mL (per mL): $2.40

Solution (Quelicin Injection)

20 mg/mL (per mL): $2.30

Solution (Succinylcholine Chloride Injection)

20 mg/mL (per mL): $1.58 - $2.40

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Acts similar to acetylcholine, produces depolarization of the motor endplate at the myoneural junction which causes sustained flaccid skeletal muscle paralysis produced by state of accommodation that develops in adjacent excitable muscle membranes

Pharmacodynamics/Kinetics

Onset of action: Dependent on route, age, and dose; data suggest faster onset with higher doses (Coté 2013):

IM: Infants and Children: 3 to 4 minutes (Liu 1981); Adults: 2 to 3 minutes

IV:

Neonates and Infants: ~30 seconds (range: 19 to 40 seconds [dose: 2 to 4 mg/kg]) (Meakin 1990)

Children and Adolescents: 35 to 55 seconds (Coté 2013); Dose-specific: 40 seconds (dose: 1.5 to 2 mg/kg); 50 seconds (dose: 1 mg/kg) (Coté 2013)

Adults: Flaccid paralysis: <60 seconds

Duration: Dependent on route, age, and dose; hypothermia may prolong the duration of action

IM: 10 to 30 minutes; Observed to be shorter in infants than children

IV: ~4 to 6 minutes; Faster recovery rate in infants and children compared to adults (Fisher 1975)

Distribution: Vd higher in neonates and infants due to larger ECF volume; higher IV doses necessary

Metabolism: Rapidly hydrolyzed by plasma pseudocholinesterase to inactive metabolites

Excretion: Urine (~10% excreted unchanged)

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Related Information

• Dosing Considerations for the Critically Ill Patient With Morbid Obesity
• Drugs With Actionable Pharmacogenomic Recommendations
• Neuromuscular-Blocking Agents

Index Terms

Succinylcholine Chloride; Suxamethonium Chloride

FDA Approval Date

August 20, 1952

References

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Brand Names: International

Anectine (AE, BB, BH, BM, BS, BZ, CY, ES, GB, GY, IE, IQ, IR, JM, JO, KW, LB, LY, MT, MX, OM, QA, SA, SR, SY, TT, YE); Anekcin (PH); Anektil (PH); Celocurin (SE); Celocurine (BE, FR); Chlorsuccillin (PL); Curacit (NO); Distensil (PE); Ethicholine (MY, SG); Fosfitone (AR, UY); Leptosuccin (HR); Lysthenon (AE, AT, BG, CH, EE, LT, LV, RO, RU, SA, TR); Midarine (IN, JO, KW); Mioflex (ES); Myoplegine (LU); Myotenlis (IT); Neosuxa (BD); Pantolax (DE); Quelicin Chloride (ID, PH); Relaxin (TW); Scoline (IN); Succi (AR); Succicholine (KR); Succinil (BR); Succinyl Asta (HU, LU); Succinyl Forte (IL); Sukolin (FI, HN); Sulax (BD); Sumeth (PK); Suxa (BD); Suxamethonium (AU, NZ); Suxameton (DK); Suxametonio cloruro (CL); Suxametonio Cloruro (PY); Uccmasuccin (EG); Vetorelaxia (EG); Zuxelax (LK)

Last Updated 4/28/20