Succinylcholine

Succinylcholine is a skeletal muscle relaxant for intravenous (IV) administration indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

• Succinylcholine is available under the following different brand names: Anectine and suxamethonium.

Dosage Forms and Strengths

Injectable solution

• 20 mg/mL
• 100 mg/mL

Dosage Considerations – Should be Given as Follows:

Neuromuscular Blockade

Adult:

Load

• 0.3-1.1 mg/kg intravenously (IV) for 1 dose, OR
• 3-4 mg/kg intramuscularly (IM) for 1 dose
• Short Procedures: usually 0.6 mg/kg IV injection

Maintenance for Prolonged Procedures

• 0.04-0.07 mg/kg intravenously (IV) every 5-10 minutes as needed OR
• 2.5 mg/min IV infusion

Pediatric:

Load

• Infants and small children: 2 mg/kg intravenously (IV) for 1 dose
• Older children and adolescents: 1 mg/kg IV for 1 dose
• 3-4 mg/kg deep intramuscularly (IM) for 1 dose; not to exceed 150 mg total dose (no adequate IV)

Maintenance

• 0.3-0.6 mg/kg intravenously (IV) every 5-10 minutes as needed

Administration

• The dose should be calculated based on ideal body weight
• Pretreatment: Atropine may reduce vagally mediated bradycardia/hypotension/drooling
• The solution contains 1% benzyl alcohol
• Prior administration of a "defasciculating" dose of nondepolarizing neuromuscular blocker (such as 0.01 mg/kg IV vecuronium) will prevent muscular fasciculations that may increase ICP/IOP
• Adequate ventilatory support mandatory may experience increased sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)

Common side effects of succinylcholine include:

• Jaw rigidity
• Low blood pressure (hypotension)
• Muscle fasciculation may result in postoperative pain
• Muscle relaxation resulting in respiratory depression to the point of breathing cessation (apnea)
• Respiratory depression
• Salivary gland enlargement

Rare side effects of succinylcholine include:

• Hypersensitivity reactions, including severe allergic reactions (anaphylaxis)
• Myoglobinuria/myoglobinemia

Serious side effects of succinylcholine include:

• Abnormal/irregular heartbeats (cardiac arrhythmias)
• Breakdown of muscle tissue (rhabdomyolysis)
• Cardiac arrest
• Excessive salivation
• Fast or slow heart rate
• High blood potassium
• High or low blood pressure
• Increased eye pressure
• Life-threatening elevation in body temperature (malignant hyperthermia)
• Muscle twitching
• Postoperative muscle pain
• Prolonged slow breathing
• Rash

This is not a complete list of side effects and other serious side effects may occur. Call your doctor for information and medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change the dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider, or pharmacist first.

• Succinylcholine has no known severe interactions with other drugs.
• Succinylcholine has serious interactions with at least 28 different drugs.
• Succinylcholine has moderate interactions with at least 182 different drugs.
• Succinylcholine has mild interactions with at least 49 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

• Muscle wasting (rhabdomyolysis) with high blood potassium (hyperkalemia) followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children have been reported in children and adolescents. The children were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. It occurs soon after administration and requires immediate treatment of hyperkalemia. Prolonged resuscitation may be required.
• Reserve for use in children for emergency intubation or in instances when immediate securing of the airway is necessary. It should be administered by trained personnel with a facility equipped to monitor, assist, and control respiration.
• This medication contains succinylcholine. Do not take Anectine or suxamethonium if you are allergic to succinylcholine or any ingredients contained in this drug.

This medication contains succinylcholine. Do not take Clinoril or Sulin if you are allergic to succinylcholine or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity to drug or component; malignant hyperthermia, lack of ventilatory support, ocular surgery, penetrating eye injuries, closed-angle glaucoma, genetically determined disorders of plasma pseudocholinesterase, history of malignant hyperthermia, myopathies associated with elevated serum creatine kinase, acute phase of injury following major burns (hyperkalemia may occur), multiple trauma, extensive denervation of skeletal muscle or upper motor neuron injury

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Succinylcholine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Succinylcholine?"

Cautions

• Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life-threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken.
• Chronic abdominal infection, subarachnoid hemorrhage, degenerative or dystrophic neuromuscular disease, conditions that may cause degeneration of central and peripheral nervous systems, upper motor neuron injury, multiple trauma, extensive denervation of skeletal muscle, electrolyte imbalance, glaucoma/eye injury (increases intraocular pressure [IOP]).
• Patients with atypical or deficient pseudocholinesterase will have prolonged paralysis (such as organophosphate/carbamate poisoning, hyperthermia, burn patient, collagen-vascular disease).
• Additive/synergistic effects if administered with or following an opioid, sedative, or anesthetic agent.
• Acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death have been reported rarely in apparently healthy children and adolescents.
• Repeated fractional doses or (to a lesser extent) continuous infusion may lead to tachyphylaxis.

Pregnancy and Lactation

• Use succinylcholine with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• It is not known if succinylcholine is excreted in breast milk; its effect on nursing infants is not known. Consult your doctor before breastfeeding.