Generic
Suxamethonium Chloride (Succinylcholine)
4 brands available in the market
At a glance
Suxamethonium Chloride (Succinylcholine) is a short-acting depolarizing neuromuscular blocking agent used for endotracheal intubation and skeletal muscle relaxation during general anesthesia.
Description
Suxamethonium Chloride is a depolarizing neuromuscular blocker that mimics the action of acetylcholine at the neuromuscular junction. It binds to nicotinic receptors, opening sodium channels and causing depolarization of the motor-end plate, resulting in muscle fasciculation. It is slowly hydrolyzed by plasma cholinesterase (butyrylcholinesterase), prolonging its duration of action.
Indications
- Facilitate endotracheal intubation
- Skeletal muscle relaxation during surgical and obstetric procedures
- Assist mechanical ventilation
Therapeutic class
Depolarizing Muscle Relaxants
Pharmacological class
Depolarizing Neuromuscular Blocker
Pharmacology
Suxamethonium binds to nicotinic acetylcholine receptors at the neuromuscular junction, causing depolarization and muscle fasciculation. Unlike acetylcholine, it is hydrolyzed slowly by plasma cholinesterase (butyrylcholinesterase), preventing muscle cell resetting and maintaining muscle relaxation.
Mechanism of action
Relaxes muscles by depolarizing the neuromuscular junction.
Dosage
Adult Dose (IV):
- Intubation: 0.3-1.1 mg/kg (onset 30-60 seconds, duration 2-6 minutes)
- Supplemental: 50-100% of initial dose at 5-10 minute intervals
- Continuous infusion: 0.1-0.2% solution at 2.5-4 mg/min; max 500 mg/hour
Adult Dose (IM):
- 3-4 mg/kg; max 150 mg
Pediatric Dose (IV):
- Infants: 2 mg/kg; older children: 1 mg/kg
- IM: 4-5 mg/kg (infants), 4 mg/kg (older children); max 150 mg
Administration
- Administered by an anesthetist in a hospital setting
- Do not self-administer
- Use only in fully anesthetized patients
Missed dose
Missed dose is not applicable (hospital administration).
Side effects
Common Side Effects:
- Bradycardia, tachycardia, hypertension, hypotension
- Bronchospasm, prolonged respiratory depression
- Muscle fasciculation, postoperative muscle pain
- Hyperthermia, increased intraocular pressure
- Rash, excessive salivation
Precautions & warnings
- Caution in genetic disorders of plasma pseudocholinesterase, personal/family history of malignant hyperthermia
- Caution in severe burns, major trauma, extensive denervation of skeletal muscle, risk of hyperkalemia
- Do not use in open eye injuries (increased intraocular pressure)
- Do not use in neonates and premature infants
Contraindications
- Genetic disorders of plasma pseudocholinesterase
- Personal or family history of malignant hyperthermia
- Severe burns, major trauma, extensive skeletal muscle denervation
- Pre-existing hyperkalemia
- Open eye injuries
- Neonates (especially premature infants)
Drug interactions
- Anticholinesterase agents (neostigmine): Prolong neuromuscular block
- Cytotoxic compounds (cyclophosphamide), antiarrhythmics (quinidine)
- Aminoglycosides, chlorpromazine, magnesium salts
- Organophosphate insecticides, digitalis-like drugs: Exacerbate hyperkalemia
Food interactions
It is not known whether alcohol is safe with Suxamethonium Chloride; consult your doctor.
Use in pregnancy
Use in Pregnancy: May be unsafe; animal studies show harmful effects; use only if clearly needed; consult your doctor.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Probably safe; limited data suggests no significant risk; consult your doctor.
Pediatric use
Do not use in neonates and premature infants; indicated for children (with dose adjustment)
Geriatric use
Elderly may be more susceptible to cardiac arrhythmias
Renal / hepatic impairment
Renal Impairment: Caution needed; dose adjustment may be needed; consult your doctor.
Hepatic Impairment: Caution needed; dose adjustment may be needed; consult your doctor.
Overdose effects
Overdose may cause prolonged respiratory depression and paralysis; provide artificial respiration and supportive treatment.
Storage conditions
Store at 2-8°C in a refrigerator; do not freeze; keep out of reach of children.
Chemical structure
Suxamethonium Chloride