Succinylcholine chloride is available as a 20-mg/mL solution in 10-mL multiple-dose vials and 5-mL single-dose prefilled syringes.3495; 3496; 3497 Each mL contains succinylcholine chloride 20 mg in water for injection with sodium chloride for isotonicity and hydrochloric acid and/or sodium hydroxide for pH adjustment.3495; 3496; 3497 Multiple-dose vials contain parabens as preservatives.3495; 3496 Succinylcholine chloride also may be available in other concentrations.3496
pH
Multiple-dose vials: 3.53495 or between 3 and 4.5.3496
Preservative-free prefilled syringes: 3.6 (3 to 4.5).3497
Osmolality
The osmolality of succinylcholine chloride 50 mg/mL was determined to be 409 mOsm/kg.1233
Osmolarity
The calculated osmolarity is 338 mOsmol/L.3496; 3497
Trade Name(s)
Anectine, Quelicin
Succinylcholine chloride is administered by direct intermittent intravenous injection or intravenous infusion, or, if necessary, by intramuscular injection.3495; 3496; 3497 For continuous intravenous infusion, the drug should be diluted in a compatible infusion solution, usually to a concentration of 1 to 2 mg/mL.3495; 3496; 3497 If a suitable vein is inaccessible, a maximum of 150 mg of the drug may be administered by intramuscular injection.3495; 3496; 3497
Succinylcholine chloride is a clear, colorless solution.3495; 3496; 3497 Intact vials or syringes should be stored at 2 to 8°C.3495; 3496; 3497 Solutions in intact containers are stated to be stable for 14 days at room temperature without significant loss of potency.1433; 3495; 3496; 3497
Research studies have looked at the stability of succinylcholine chloride above refrigeration temperature. In one study, storage for 7 days at 40°C followed by storage at 25°C for four weeks was used to simulate the worst case of shipping followed by storage on an emergency cart. Calculated loss at room temperature was 1%/week; at 40°C, it was 3.2%/week. Therefore, the loss was estimated to be about 7% under such conditions.960
In another study, similar results were found. The decomposition rate of succinylcholine chloride was dependent on both concentration and temperature. The calculated degradation rates at room temperature were all higher for the 50-mg/mL concentration (2.1%/month) compared to the 20-mg/mL injection (1.2%/month). The time to 10% decomposition on an emergency cart was about 4.8 months for the 50-mg/mL concentration and was about 8.3 months for the 20-mg/mL concentration. Refrigeration cut the decomposition rates to 0.3 and 0.18% per month, respectively.2742
However, a somewhat shorter time to 10% decomposition at room temperature has also been reported. Commercial vials of succinylcholine chloride 20 mg/mL (Quelicin) stored at room temperature were found to decompose about 10 to 11% drug in 6 months. The authors recommended limiting room temperature storage to not more than 6 months.2763
Manufacturers recommend diluted solutions be stored at 2 to 8°C and used within 24 hours of preparation.3495; 3496; 3497 Unused portions should be discarded.3495; 3496; 3497
pH Effects
The pH of maximum stability was found to be 3.75 to 4.50.960 Succinylcholine chloride is unstable in alkaline solutions and may not be compatible with solutions having a pH greater than 8.5 (e.g., barbiturate solutions).3495; 3496; 3497 Do not mix succinylcholine chloride with alkaline solutions.3495; 3496; 3497
Syringes
Succinylcholine chloride (Abbott) 20 mg/mL was packaged in both glass and polypropylene syringes (Becton Dickinson) sealed with rubber luer-tip caps (Becton Dickinson). The syringes were stored for 45 days at 4°C, 22°C and 50% relative humidity, and 37°C and 85% relative humidity. At 4°C, there was little or no succinylcholine chloride loss after 45 days in either glass or plastic syringes. At 22°C and 50% relative humidity, about a 5% loss occurred in 45 days. However, at 37°C and 85% relative humidity, the drug concentration fell below the acceptable USP limit after about 30 days.1209
Succinylcholine chloride (Burroughs Wellcome) 20 mg/mL in dextrose 5% and in sodium chloride 0.9% (Baxter) was packaged as 10 mL in 12-mL plastic syringes (Monoject) and wrapped in aluminum foil. Little or no loss of succinylcholine chloride occurred during 107 days of storage at 5°C. At 25°C, about 5 to 6% loss occurred in 100 days. Samples at an elevated temperature of 40°C were stable through 22 days with only 3 to 4% loss but exhibited 12 to 14% loss at 63 days.1892
Succinylcholine chloride (Abbott) 20 mg/mL was packaged as 8 mL of undiluted injection in 12-mL polypropylene syringes (Becton Dickinson) and was stored at 4°C and 25°C exposed to fluorescent light. The injection remained visually clear at both temperatures. Little or no loss of succinylcholine chloride occurred in 90 days when stored at 4°C. However, at 25°C losses of about 6, 10, and 12% occurred in 45, 60, and 90 days, respectively.2438
Syringes prefilled with succinylcholine chloride injection for emergency use have been reported to freeze upon storage under refrigeration. Care should be taken to make sure that refrigerators are operating within compendial temperature ranges to ensure the availability of stored drugs in emergencies.2698; 2699
For a list of references cited in the text of this monograph, search the monograph titled References.