Dosing & Uses
Dosage Forms & Strengths
Maintenance for Prolonged Procedures
- 0.04-0.07 mg/kg IV q5-10min PRN OR
- 2.5 mg/min IV infusion
Dose should be calculated based on ideal body weight
Pretreatment: Atropine may reduce vagally mediated bradycardia/hypotension/drooling
Solution contains 1% benzyl alcohol
Prior administration of "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)
Dosage Forms & Strengths
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Muscle fasciculation which may result in postoperative pain
Salivary gland enlargement
Black Box Warnings
Rhabdomyolysis with 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 airway is necessary. It should be administered by trained personnel with a facility equipped to monitor, assist, and control respiration.
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
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 & peripheral nervous systems, upper motor neuron injury, multiple trauma, extensive denervation of skeletal muscle, electrolyte imbalance, glaucoma/eye injury (increases 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, & death have been reported rarely in apparently healthy children & adolescents
Repeated fractional doses or (to a lesser extent) continuous infusion may lead to tachyphylaxis
Pregnancy & Lactation
Pregnancy Category: C
Lactation: not known if excreted in breast milk; effect on nursing infant not known
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Depolarizing skeletal muscle relaxant; depolarizes motor endplate at myoneural junction, which causes sustained flaccid skeletal muscle paralysis; no effect on consciousness, pain
Onset: 30-60 sec (IV); 2-3 min (IM)
Duration: 4-6 min (IV); 10-30 min (IM)
Metabolism: Rapid, by plasma pseudocholinesterase to weakly active metabolite
Metabolites: Succinylmonocholine & choline
Increased incidence of malignant hyperthermia with use of volatile anesthetics or depolarizing neuromuscular blockers in patients with gene mutations in ryanodine receptor (RYR1) or calcium channel alpha (1S)- subunit gene (CACNA1S)
Additive: methohexital, nafcillin, pentobarbital, sodium bicarbonate, thiopental
Y-site: methohexital, thiopental
Solution: compatible with most common solvents
Additive: amikacin, isoproterenol, meperidine, methyldopate, morphine, norepinephrine, scopolamine
Y-site: etomidate, heparin/hydrocortisone, Hextend, KCl, propofol, vit B/C
Cont Infusion: dilute to 1-2 mg/mL w/ D5W, D5/NS, NS or Na-lactate 1/6M
IM: IM injections should be made deeply, preferably high into deltoid muscle
IV: may be given by rapid IV injection (10-30 sec) without further dilution
Cont IV infusion: 2.5 mg/min (range: 0.5-10 mg/min)
Refrigerate at 2-8°C (36-46°F)
Powder form does not require refrigeration
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
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