Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 20mg/mL
- 100mg/mL
Neuromuscular Blockade
Load
Maintenance for Prolonged Procedures
- 0.04-0.07 mg/kg IV q5-10min PRN OR
- 2.5 mg/min IV infusion
Dosing Considerations
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
injectable solution
- 20mg/mL
- 100mg/mL
Neuromuscular Blockade
Load
- Infants and small children: 2 mg/kg IV x1 dose
- Older children and adolescents: 1 mg/kg IV x1 dose
- 3-4 mg/kg deep IM x1 dose; not to exceed 150 mg total dose (no adequate IV)
Maintenance
- 0.3-0.6 mg/kg IV q5-10min PRN
Dosing Considerations
- 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)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (29)
- amikacin
amikacin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- amphotericin B deoxycholate
amphotericin B deoxycholate increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, succinylcholine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- capreomycin
capreomycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- clindamycin
clindamycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- colistin
succinylcholine increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- demeclocycline
demeclocycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- doxycycline
doxycycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- echothiophate iodide
echothiophate iodide increases levels of succinylcholine by decreasing metabolism. Avoid or Use Alternate Drug.
- fentanyl
fentanyl, succinylcholine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl intranasal
fentanyl intranasal, succinylcholine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transdermal
fentanyl transdermal, succinylcholine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transmucosal
fentanyl transmucosal, succinylcholine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- gentamicin
gentamicin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- hydrocodone
hydrocodone, succinylcholine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- lincomycin
lincomycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- minocycline
minocycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- neomycin PO
neomycin PO increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- omadacycline
omadacycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- oxytetracycline
oxytetracycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- paromomycin
paromomycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- polymyxin B
polymyxin B increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of resp. depression.
- quinine
quinine increases effects of succinylcholine by pharmacodynamic synergism. Contraindicated. Risk of resp. depression.
- sarecycline
sarecycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- streptomycin
streptomycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- sufentanil SL
sufentanil SL, succinylcholine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- tetracycline
tetracycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- tobramycin
tobramycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- valerian
valerian and succinylcholine both increase sedation. Avoid or Use Alternate Drug.
Monitor Closely (180)
- abobotulinumtoxinA
succinylcholine increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Neuromuscular blockers may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- acebutolol
acebutolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- aceclofenac
aceclofenac and succinylcholine both increase serum potassium. Use Caution/Monitor.
- acemetacin
acemetacin and succinylcholine both increase serum potassium. Use Caution/Monitor.
- aclidinium
succinylcholine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- albuterol
succinylcholine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amiloride
amiloride and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- amitriptyline
succinylcholine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- amoxapine
succinylcholine increases and amoxapine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- anticholinergic/sedative combos
succinylcholine increases and anticholinergic/sedative combos decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- arformoterol
succinylcholine increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aspirin
aspirin and succinylcholine both increase serum potassium. Use Caution/Monitor.
- aspirin rectal
aspirin rectal and succinylcholine both increase serum potassium. Use Caution/Monitor.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate and succinylcholine both increase serum potassium. Use Caution/Monitor.
- atenolol
atenolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- atracurium
succinylcholine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atropine
succinylcholine increases and atropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atropine IV/IM
succinylcholine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- belladonna alkaloids
succinylcholine increases and belladonna alkaloids decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
succinylcholine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bendroflumethiazide
succinylcholine increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- betamethasone
succinylcholine, betamethasone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- betaxolol
betaxolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- bethanechol
bethanechol and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- bisoprolol
bisoprolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- bumetanide
succinylcholine increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- buprenorphine, long-acting injection
succinylcholine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- canagliflozin
succinylcholine and canagliflozin both increase serum potassium. Use Caution/Monitor.
- carbachol
carbachol and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- carbenoxolone
succinylcholine increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- celecoxib
celecoxib and succinylcholine both increase serum potassium. Use Caution/Monitor.
- celiprolol
celiprolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- cevimeline
cevimeline and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- chlorothiazide
succinylcholine increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorthalidone
succinylcholine increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- choline magnesium trisalicylate
choline magnesium trisalicylate and succinylcholine both increase serum potassium. Use Caution/Monitor.
- cisatracurium
succinylcholine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
succinylcholine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- corticotropin
succinylcholine, corticotropin. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- cortisone
succinylcholine, cortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- cyclizine
succinylcholine increases and cyclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclobenzaprine
succinylcholine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclopenthiazide
succinylcholine increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclophosphamide
cyclophosphamide increases levels of succinylcholine by decreasing metabolism. Use Caution/Monitor. Neuromuscular blockade may be prolonged because of inhibition of cholinesterase activity. Prolonged respiratory depression with extended periods of apnea may occur. .
- darifenacin
succinylcholine increases and darifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- deflazacort
succinylcholine, deflazacort. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- dexamethasone
succinylcholine, dexamethasone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- diclofenac
diclofenac and succinylcholine both increase serum potassium. Use Caution/Monitor.
- dicyclomine
succinylcholine increases and dicyclomine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diflunisal
diflunisal and succinylcholine both increase serum potassium. Use Caution/Monitor.
- digoxin
digoxin and succinylcholine both increase serum potassium. Use Caution/Monitor.
succinylcholine, digoxin. Mechanism: unknown. Use Caution/Monitor. Increased risk of cardiac arrhythmias. - diphenhydramine
succinylcholine increases and diphenhydramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
succinylcholine increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- donepezil
donepezil and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- donepezil transdermal
donepezil transdermal and succinylcholine both increase pharmacodynamic synergism. Use Caution/Monitor. Donepezil transdermal, a cholinesterase inhibitor, may potentiate the effects on muscle relacation during anesthesia.
- dopexamine
succinylcholine increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
succinylcholine increases and dosulepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxapram
doxapram decreases effects of succinylcholine by pharmacodynamic antagonism. Use Caution/Monitor.
- doxepin
succinylcholine increases and doxepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- drospirenone
drospirenone and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- echothiophate iodide
echothiophate iodide and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- ephedrine
succinylcholine increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
succinylcholine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
succinylcholine increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esmolol
esmolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- ethacrynic acid
succinylcholine increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac and succinylcholine both increase serum potassium. Use Caution/Monitor.
- fenoprofen
fenoprofen and succinylcholine both increase serum potassium. Use Caution/Monitor.
- fesoterodine
succinylcholine increases and fesoterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- finerenone
succinylcholine and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
- flavoxate
succinylcholine increases and flavoxate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fludrocortisone
succinylcholine, fludrocortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- flurbiprofen
flurbiprofen and succinylcholine both increase serum potassium. Use Caution/Monitor.
- formoterol
succinylcholine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- furosemide
succinylcholine increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- galantamine
galantamine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- gentamicin
succinylcholine increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glycopyrrolate
succinylcholine increases and glycopyrrolate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glycopyrrolate inhaled
succinylcholine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- henbane
succinylcholine increases and henbane decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- homatropine
succinylcholine increases and homatropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- huperzine A
huperzine A and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- hydrochlorothiazide
succinylcholine increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocortisone
succinylcholine, hydrocortisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- hyoscyamine
succinylcholine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hyoscyamine spray
succinylcholine increases and hyoscyamine spray decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- ibuprofen
ibuprofen and succinylcholine both increase serum potassium. Use Caution/Monitor.
- ibuprofen IV
ibuprofen IV and succinylcholine both increase serum potassium. Use Caution/Monitor.
- imipramine
succinylcholine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indapamide
succinylcholine increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indomethacin
indomethacin and succinylcholine both increase serum potassium. Use Caution/Monitor.
- ipratropium
succinylcholine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- isoproterenol
succinylcholine increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketoprofen
ketoprofen and succinylcholine both increase serum potassium. Use Caution/Monitor.
- ketorolac
ketorolac and succinylcholine both increase serum potassium. Use Caution/Monitor.
- ketorolac intranasal
ketorolac intranasal and succinylcholine both increase serum potassium. Use Caution/Monitor.
- labetalol
labetalol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- levalbuterol
succinylcholine increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
succinylcholine increases and lofepramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lornoxicam
lornoxicam and succinylcholine both increase serum potassium. Use Caution/Monitor.
- magnesium sulfate
magnesium sulfate increases effects of succinylcholine by pharmacodynamic synergism. Use Caution/Monitor. Interaction occurs with parenteral magnesium.
- magnesium supplement
magnesium supplement, succinylcholine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.
- maprotiline
succinylcholine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meclizine
succinylcholine increases and meclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meclofenamate
meclofenamate and succinylcholine both increase serum potassium. Use Caution/Monitor.
- mefenamic acid
mefenamic acid and succinylcholine both increase serum potassium. Use Caution/Monitor.
- meloxicam
meloxicam and succinylcholine both increase serum potassium. Use Caution/Monitor.
- metaproterenol
succinylcholine increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methscopolamine
succinylcholine increases and methscopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methyclothiazide
succinylcholine increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylprednisolone
succinylcholine, methylprednisolone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- metoclopramide intranasal
metoclopramide intranasal increases effects of succinylcholine by Other (see comment). Use Caution/Monitor. Comment: Metoclopramide may enhance the neuromuscular-blocking effect of succinylcholine or mivacurium.Monitor for signs and symptoms of prolonged neuromuscular blockade.
- metolazone
succinylcholine increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
metoprolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- nabumetone
nabumetone and succinylcholine both increase serum potassium. Use Caution/Monitor.
- nadolol
nadolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- naproxen
naproxen and succinylcholine both increase serum potassium. Use Caution/Monitor.
- nebivolol
nebivolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- neostigmine
neostigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- norepinephrine
succinylcholine increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
succinylcholine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oliceridine
oliceridine, succinylcholine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- onabotulinumtoxinA
succinylcholine increases and onabotulinumtoxinA decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- orphenadrine
succinylcholine increases and orphenadrine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxaprozin
oxaprozin and succinylcholine both increase serum potassium. Use Caution/Monitor.
- oxybutynin
succinylcholine increases and oxybutynin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxybutynin topical
succinylcholine increases and oxybutynin topical decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxybutynin transdermal
succinylcholine increases and oxybutynin transdermal decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases effects of succinylcholine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Oxycodone may enhance the neuromuscular blocking action of true skeletal muscle relaxants and produce an increased degree of respiratory depression.
- pancuronium
succinylcholine increases and pancuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
parecoxib and succinylcholine both increase serum potassium. Use Caution/Monitor.
- penbutolol
penbutolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- physostigmine
physostigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- pilocarpine
pilocarpine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- pindolol
pindolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- pirbuterol
succinylcholine increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- piroxicam
piroxicam and succinylcholine both increase serum potassium. Use Caution/Monitor.
- potassium acid phosphate
potassium acid phosphate and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
potassium chloride and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
potassium citrate and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate/citric acid
succinylcholine and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.
- pralidoxime
succinylcholine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- prednisolone
succinylcholine, prednisolone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- prednisone
succinylcholine, prednisone. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- propantheline
succinylcholine increases and propantheline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- propranolol
propranolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- protriptyline
succinylcholine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pyridostigmine
pyridostigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- rapacuronium
succinylcholine increases and rapacuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rivastigmine
rivastigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor. Potential for prolonged neuromuscular blockade. Rivastigmine may increase serum concentration of succinylcholine.
- rocuronium
succinylcholine increases and rocuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. Should not administer rocuronium until recovery from succinylcholine observed .
- sacubitril/valsartan
sacubitril/valsartan and succinylcholine both increase serum potassium. Use Caution/Monitor.
- salicylates (non-asa)
salicylates (non-asa) and succinylcholine both increase serum potassium. Use Caution/Monitor.
- salmeterol
succinylcholine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salsalate
salsalate and succinylcholine both increase serum potassium. Use Caution/Monitor.
- scopolamine
succinylcholine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sevoflurane
sevoflurane increases levels of succinylcholine by pharmacodynamic synergism. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases effects of succinylcholine by Other (see comment). Use Caution/Monitor. Comment: Magnesium may potentiate the effects of the neuromuscular blocking agents.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases effects of succinylcholine by Other (see comment). Use Caution/Monitor. Comment: Magnesium may potentiate the effects of the neuromuscular blocking agents.
- solifenacin
succinylcholine increases and solifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sotalol
sotalol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- spironolactone
spironolactone and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- sulfasalazine
sulfasalazine and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulindac
sulindac and succinylcholine both increase serum potassium. Use Caution/Monitor.
- terbutaline
succinylcholine increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- timolol
timolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- tiotropium
succinylcholine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tobramycin inhaled
tobramycin inhaled increases effects of succinylcholine by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Aminoglycosides may aggravate muscle weakness because of a curare-like effect.
- tolfenamic acid
tolfenamic acid and succinylcholine both increase serum potassium. Use Caution/Monitor.
- tolmetin
tolmetin and succinylcholine both increase serum potassium. Use Caution/Monitor.
- tolterodine
succinylcholine increases and tolterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolvaptan
succinylcholine and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
succinylcholine increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triamcinolone acetonide injectable suspension
succinylcholine, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.
- triamterene
triamterene and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.
- trimipramine
succinylcholine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trospium chloride
succinylcholine increases and trospium chloride decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- vecuronium
succinylcholine increases and vecuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- voclosporin
voclosporin and succinylcholine both increase serum potassium. Use Caution/Monitor.
Minor (44)
- acetazolamide
acetazolamide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- amlodipine
amlodipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- carbamazepine
carbamazepine decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- clevidipine
clevidipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- clonazepam
clonazepam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- desipramine
succinylcholine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- diazepam
diazepam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- diltiazem
diltiazem increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- donepezil
donepezil increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown.
- eslicarbazepine acetate
eslicarbazepine acetate decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- ethosuximide
ethosuximide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- felbamate
felbamate decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- felodipine
felodipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- fosphenytoin
fosphenytoin decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- gabapentin
gabapentin decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- gabapentin enacarbil
gabapentin enacarbil decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- galantamine
galantamine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown.
- isradipine
isradipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- lacosamide
lacosamide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- lamotrigine
lamotrigine decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- levetiracetam
levetiracetam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- lithium
lithium increases effects of succinylcholine by unknown mechanism. Minor/Significance Unknown.
- lorazepam
lorazepam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- methsuximide
methsuximide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- nicardipine
nicardipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- nifedipine
nifedipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- nisoldipine
nisoldipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- noni juice
noni juice and succinylcholine both increase serum potassium. Minor/Significance Unknown.
- oxcarbazepine
oxcarbazepine decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- pantothenic acid
pantothenic acid, succinylcholine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- phenelzine
phenelzine increases levels of succinylcholine by decreasing metabolism. Minor/Significance Unknown.
- phenobarbital
phenobarbital decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- phenytoin
phenytoin decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- primidone
primidone decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- procainamide
procainamide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- quinidine
quinidine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown.
- rufinamide
rufinamide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- thiamine
thiamine increases effects of succinylcholine by unspecified interaction mechanism. Minor/Significance Unknown.
- tiagabine
tiagabine decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- topiramate
topiramate decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- trazodone
succinylcholine increases and trazodone decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- valproic acid
valproic acid decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
- verapamil
verapamil increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.
- zonisamide
zonisamide decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Muscle fasciculation which may result in postoperative pain
Jaw rigidity
Apnea
Respiratory depression
Bradycardia
Hypotension
Cardiac arrhythmias
Sinus tachycardia
Increased IOP
Salivary gland enlargement
Excessive salivation
Rash
Hypersensitivity reactions
Malignant hyperthermia
Myoglobinuria/myoglobinemia (rare)
Warnings
Black Box Warnings
Acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death has occurred after administration of succinylcholine to apparently healthy pediatric patients who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy
When a healthy appearing, pediatric patient develops cardiac arrest within minutes after administration of drug, not felt to be due to inadequate ventilation, oxygenation or anesthetic overdose, immediate treatment for hyperkalemia should be instituted; in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently
Reserve the use of this drug in pediatric patients for emergency intubation or instances where immediate securing of the airway is necessary, eg, laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible
Contraindications
Hypersensitivity to drug or component; known or suspected genetic susceptibility to malignant hyperthermia, lack of ventilatory support, 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
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
Use caution in 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
Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent
Death due to errors reported; administration of drug results in paralysis, which may lead to respiratory arrest and death; this progression may be more likely to occur in a patient for whom it is not intended; confirm proper selection of intended product and avoid confusion with other injectable solutions that are present in critical care and other clinical settings; if another healthcare provider is administering the product, ensure that the intended dose is clearly labeled and communicated
Succinylcholine causes an increase in intraocular pressure; avoid this drug in instances in which an increase in intraocular pressure is undesirable (eg, narrow angle glaucoma, penetrating eye injury) unless potential benefit of its use outweighs potential risk
Drug should be employed with caution in patients with fractures or muscle spasm because initial muscle fasciculations may cause additional trauma; monitor neuromuscular transmission and development of fasciculations throughout use of neuromuscular blocking agent
Use may cause a transient increase in intracranial pressure; however, adequate anesthetic induction prior to administration of the drug will minimize this effect
Succinylcholine may increase intragastric pressure, which could result in regurgitation and possible aspiration of stomach contents; evaluate patients at risk for aspiration and regurgitation; monitor patients during induction of anesthesia and neuromuscular blockade for clinical signs of vomiting and/or aspiration
Neuromuscular blockade may be prolonged in patients with hypokalemia (eg, after severe vomiting, diarrhea, digitalisation and diuretic therapy) or hypocalcemia (eg, after massive transfusions); correct severe electrolyte disturbances when possible; in order to help preclude possible prolongation of neuromuscular block, monitor neuromuscular transmission throughout use
Neuromuscular blockade in conscious patient can lead to distress; use drug in the presence of appropriate sedation or general anesthesia; monitor patients to ensure that the level of anesthesia is adequate; in emergency situations, however, it may be necessary to administer the drug before unconsciousness is induced
Ventricular dysrhythmias in pediatric patients
- Acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death reported rarely in apparently healthy children and adolescents
- Due to the abrupt onset of syndrome, routine resuscitative measures are likely to be unsuccessful
- Careful monitoring of electrocardiogram may alert the practitioner to peaked T-waves (an early sign)
- Administration of intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation have resulted in successful resuscitation in some reported cases
- Extraordinary and prolonged resuscitative efforts effective in some cases
- In the presence of signs of malignant hyperthermia, appropriate treatment should be initiated concurrently
- Because of difficulty to identify which patients are at risk, reserve use in pediatric patients for emergency intubation or instances where immediate securing of airway is necessary, eg, laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible
Hyperkalemia
- Drug may induce serious cardiac arrhythmias or cardiac arrest due to hyperkalemia in patients with electrolyte abnormalities and those who may have digitalis toxicity
- The risk of hyperkalemia in patients with acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury increases over time and usually peaks at 7 to 10 days after the injury
- The risk is dependent on extent and location of injury; the precise time of onset and duration of risk period are undetermined
- Patients with chronic abdominal infection, subarachnoid hemorrhage, or conditions causing degeneration of central and peripheral nervous systems are at an increased risk of developing severe hyperkalemia after drug administration
- Consider avoiding use in these patients or verify patient’s baseline potassium levels are within normal range prior to drug administration
Hyperthermia
- Succinylcholine administration has been associated with acute onset of malignant hyperthermia, a potentially fatal hypermetabolic state of skeletal muscle leading to high oxygen demand; fatal outcomes of malignant hyperthermia reported
- Therapy can induce malignant hyperthermia in patients with known or suspected susceptibility based on genetic factors or family history, including those with certain inherited ryanodine receptor (RYR1) or dihydropyridine receptor (CACNA1S) variants
- The risk of developing malignant hyperthermia following administration increases with concomitant administration of volatile anesthetics
- Malignant hyperthermia frequently presents as intractable spasm of the jaw muscles (masseter spasm) which may progress to generalized rigidity, increased oxygen demand, tachycardia, tachypnea and profound hyperpyrexia
- Signs consistent with malignant hyperthermia may include hyperthermia, hypoxia, hypercapnia, muscle rigidity (eg, jaw muscle spasm), tachycardia (eg, particularly that unresponsive to deepening anesthesia or analgesic medication administration), tachypnea, cyanosis, arrhythmias, hypovolemia, and hemodynamic instability; skin mottling, coagulopathies, and renal failure may occur later in the course of the hypermetabolic process
- Successful treatment of malignant hyperthermia depends on early recognition of clinical signs; if malignant hyperthermia is suspected, discontinue all triggering agents (eg, volatile anesthetic agents and succinylcholine), administer intravenous dantrolene sodium, and initiate supportive therapies
- Skin mottling, rising temperature and coagulopathies may occur later in the course of the hypermetabolic process
- Recognition of the syndrome is a signal for discontinuance of anesthesia, attention to increased oxygen consumption, correction of acidosis, support of circulation, assurance of adequate urinary output and institution of measures to control rising temperature
- Intravenous dantrolene sodium is recommended as an adjunct to supportive measures in the management of malignant hyperthermia
- Consult prescribing information for intravenous dantrolene sodium for additional information on patient management; supportive therapies include administration of supplemental oxygen and respiratory support based on clinical need, maintenance of hemodynamic stability and adequate urinary output, management of fluid and electrolyte balance, correction of acid-base derangements, and institution of measures to control rising temperature
- Continuous monitoring of temperature and expired CO2 is recommended as an aid to early recognition of malignant hyperthermia
Bradycardia
- Intravenous bolus administration in pediatric patients (including infants) may result in profound bradycardia or, rarely, asystole
- In both adult and pediatric patients, the incidence of bradycardia, which may progress to asystole, is higher following a second dose of succinylcholine
- The incidence and severity of bradycardia is higher in pediatric patients than adults; whereas bradycardia is common in pediatric patients after an initial dose of 1.5 mg/kg, bradycardia is seen in adults only after repeated exposure
- Pretreatment with anticholinergic agents (eg, atropine) may reduce occurrence of bradyarrhythmias
Prolonged neuromuscular block
- When given over a prolonged period of time, the characteristic depolarization block of the myoneural junction (Phase I block) may change to a block with characteristics superficially resembling a non-depolarizing block (Phase II block)
- Prolonged respiratory muscle paralysis or weakness may be observed in patients manifesting this transition to Phase II block; tachyphylaxis occurs with repeated administration
- When Phase II block is suspected in cases of prolonged neuromuscular blockade, make positive diagnosis by peripheral nerve stimulation, prior to administration of any anticholinesterase drug
- Reversal of Phase II block is a medical decision which must be made upon basis of the patient, clinical pharmacology, and experience and judgment of the clinician
- The presence of Phase II block is indicated by fade of responses to successive stimuli (preferably "train of four"); the use of an anticholinesterase drug such as neostigmine to reverse Phase II block should be accompanied by appropriate doses of an anticholinergic drug to prevent disturbances of cardiac rhythm
- After adequate reversal of Phase II block with an anticholinesterase agent, the patient should be continually observed for at least 1 hour for signs of return of muscle relaxation
- Reversal should not be attempted unless a peripheral nerve stimulator is used to determine the presence of Phase II block (since anticholinesterase agents will potentiate succinylcholine-induced Phase I block), and spontaneous recovery of muscle twitch has been observed for at least 20 minutes and has reached a plateau with further recovery proceeding slowly
- This delay is to ensure complete hydrolysis of succinylcholine by plasma cholinesterase prior to administration of the anticholinesterase agent
- Should the type of block be misdiagnosed, depolarization of the type initially induced by succinylcholine (ie, Phase I block) will be prolonged by an anticholinesterase agent
Reduced plasma cholinesterase activity
- Use not recommended in patients with known reduced plasma cholinesterase (pseudocholinesterase) activity due to likelihood of prolonged neuromuscular block following administration of in such patients
- Plasma cholinesterase activity may be diminished in the presence of genetic abnormalities of plasma cholinesterase (eg, patients heterozygous or homozygous for atypical plasma cholinesterase gene), pregnancy, severe liver or kidney disease, malignant tumors, infections, burns, anemia, decompensated heart disease, peptic ulcer, or myxedema
- Plasma cholinesterase activity may also be diminished by chronic administration of oral contraceptives, glucocorticoids, or certain monoamine oxidase inhibitors and by irreversible inhibitors of plasma cholinesterase (eg, organophosphate insecticides, echothiophate, and certain antineoplastic drugs)
- Patients homozygous for atypical plasma cholinesterase gene (1 in 2,500 patients) are extremely sensitive to neuromuscular blocking effect of succinylcholine
- If drug is administered to a patient homozygous for atypical plasma cholinesterase, resulting apnea or prolonged muscle paralysis should be treated with controlled respiration
Pregnancy & Lactation
Pregnancy
Not known whether succinylcholine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; animal reproduction studies not conducted with succinylcholine chloride; therapy should be administered to a pregnant woman only if clearly needed
Labor and delivery
- Drug is commonly used to provide muscle relaxation during delivery by Cesarean section; while small amounts of succinylcholine are known to cross placental barrier, under normal conditions the quantity of drug that enters fetal circulation after a single dose of 1 mg/kg to mother should not endanger fetus; however, since amount of drug that crosses the placental barrier is dependent on concentration gradient between maternal and fetal circulations, residual neuromuscular blockade (apnea and flaccidity) may occur in the neonate after repeated high doses to, or in the presence of atypical plasma cholinesterase in, the mother
Lactation
Not known whether drug excreted in human milk; because many drugs are excreted in human milk, use caution following succinylcholine administration to a nursing woman
Pregnancy Categories
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.Pharmacology
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
Pharmacokinetics
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
Excretion: Urine
Pharmacogenomics
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)
Administration
Solution Preparation
Visually inspect for particulate matter and discoloration prior to administration, whenever solution and container permit; do not administer solutions that are not clear and colorless
Drug supplied in single-dose vials must be diluted before use
Drug supplied in multiple-dose vials does not require dilution before use
Drug may be diluted to 1 mg/mL or 2 mg/mL in a solution such as: 5% Dextrose Injection, USP, or 0.9% Sodium Chloride Injection, USP
Prepare the diluted solution for single patient use only
Administration Information
Dose should be calculated based on ideal body weight
For intravenous or intramuscular use only
Must be titrated to effect by or under supervision of experienced clinicians who are familiar with its actions and with appropriate neuromuscular monitoring techniques
Should be administered only by those skilled in management of artificial respiration and only when facilities are instantly available for tracheal intubation and for providing adequate ventilation of patient, including administration of oxygen under positive pressure and the elimination of CO2.
The clinician must be prepared to assist or control respiration
The dosage of should be individualized and always determined by the clinician after careful assessment of patient
To avoid distress to patient, do not administer drug before unconsciousness has been induced
The occurrence of bradyarrhythmias with administration of drug may be reduced by pretreatment with anticholinergics (eg, atropine)
Monitor neuromuscular function with a peripheral nerve stimulator when administering by infusion
Intramuscular administration in adults and pediatric patients
- If a suitable vein is inaccessible, drug may be administered intramuscularly at a dose of up to 3 mg/kg to 4 mg/kg to infants, older pediatric patients, or adults
- The total dose administered by the intramuscular route should not exceed 150 mg
- The onset of effect of succinylcholine given intramuscularly is usually observed in about 2 to 3 minutes
Short surgical procedures
- Following intravenous administration of doses in recommended range, neuromuscular blockade develops in about 1 minute; maximum blockade may persist for about 2 minutes, after which recovery takes place within 4 to 6 minutes; a 5 to 10 mg intravenous test dose may be used to determine sensitivity of the patient and individual recovery time
Long surgical procedures
-
Continuous infusion
- Dosage administered by continuous intravenous infusion depends upon duration of surgical procedure and need for muscle relaxation; diluted solutions containing from 1 mg/mL to 2 mg/mL succinylcholine have commonly been used for continuous intravenous infusion
- The more dilute solution (1 mg/mL) is probably preferable from standpoint of ease of control of rate of administration and, hence, of relaxation
- Diluted solution containing 1 mg/mL succinylcholine may be administered intravenously at a rate of 0.5 mg (0.5 mL) per minute to 10 mg (10 mL) per minute to obtain the required amount of relaxation
- The amount required per minute will depend upon individual response as well as degree of relaxation required
- The average rate of continuous intravenous infusion for an adult ranges between 2.5 mg per minute and 4.3 mg per minute
- Monitor neuromuscular function with a peripheral nerve stimulator when administered by infusion in order to avoid overdose, detect development of Phase II block, follow its rate of recovery, and assess the effects of reversing agents
-
Intermittent intravenous infusion
- Intermittent intravenous injections may be used to provide muscle relaxation for long procedures; an intravenous injection of 0.3 mg/kg to 1.1 mg/kg may be given initially, followed, at appropriate intervals, by further intravenous injections of 0.04 mg/kg to 0.07 mg/kg to maintain the degree of relaxation required
Intravenous administration in pediatric patients
- For emergency tracheal intubation or in instances where immediate securing of the airway is necessary, intravenous dose of is 2 mg/kg for infants and other small pediatric patients
- For older pediatric patients and adolescents, the intravenous dose is 1 mg/kg
- The effective dose in pediatric patients may be higher than that predicted by body weight dosing alone; for example, usual adult intravenous dose of 0.6 mg/kg is comparable to a dose of 2 mg/kg to 3 mg/kg in neonates and infants up to 6 months of age and 1 mg/kg to 2 mg/kg in infants up to 2 years of age
IV Incompatibilities
Additive: methohexital, nafcillin, pentobarbital, sodium bicarbonate, thiopental
Y-site: methohexital, thiopental
IV Compatibilities
Solution: compatible with most common solvents
Additive: amikacin, isoproterenol, meperidine, methyldopate, morphine, norepinephrine, scopolamine
Syringe: heparin
Y-site: etomidate, heparin/hydrocortisone, Hextend, KCl, propofol, vit B/C
IV/IM Administration
IM injections should be made deeply, preferably high into deltoid muscle
May be given by rapid IV injection (10-30 sec) without further dilution
Storage
Store diluted solution in a refrigerator [2 °C to 8 °C (36 °F to 46 °F)] and use within 24 hours after preparation
Powder form does not require refrigeration
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Quelicin injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| succinylcholine chloride injection - | 20 mg/mL vial |  | |
| Anectine injection - | 20 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
succinylcholine chloride injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
