succinylcholine

Contraindicated in:

Hypersensitivity to succinylcholine or parabens
Plasma pseudocholinesterase deficiency
Pedi: Children and neonates (continuous infusions)
Personal history of malignant hyperthermia.

Use Cautiously in:

History of anaphylaxis to other neuromuscular blockers
Familial history of malignant hyperthermia
History of pulmonary disease, renal or liver impairment
Major trauma, burns, or underlying myopathy (↑ risk of rhabdomyolysis and hyperkalemia, especially in children or adolescents)
Glaucoma
Electrolyte disturbances
Receiving digoxin
Fractures or muscular spasm
Myasthenia gravis or myasthenic syndromes
Geri: Geriatric or debilitated patients
OB: Has been used in pregnant women undergoing cesarean section
Pedi: Children and neonates (↑ risk of malignant hyperthermia).

Adv. Reactions/Side Effects ⬆ ⬇

Most adverse reactions to succinylcholine are extensions of pharmacologic effects

Resp: APNEA, bronchospasm.

CV: arrhythmias, bradycardia, hypotension.

F and E: HYPERKALEMIA.

MS: RHABDOMYOLYSIS, muscle fasciculation.

Misc: ANAPHYLAXIS, MALIGNANT HYPERTHERMIA, myoglobinemia (↑ in children), myoglobinuria (↑ in children), tachyphylaxis.

Interactions ⬆ ⬇

Drug-Drug:

Intensity and/or duration of paralysis may be prolonged by pretreatment with general anesthesia, aminoglycosides, polymyxin B, colistin, clindamycin, lidocaine, quinidine, procainamide, beta blockers, lithium, cyclophosphamide, phenelzine, potassium-losing diuretics, and magnesium salts.
↑risk of adverse cardiovascular reactions with opioid analgesics or digoxin.

Route/Dosage ⬆ ⬇

IV route is preferred, but deep IM injection may be used in children and patients without vascular access

Test Dose

IV (Adults): 5–10 mg (0.1 mg/kg), then assess respiratory function.

Short Procedures

IV (Adults): 0.6 mg/kg (range 0.3–1.1 mg/kg) up to 150 mg total dose; additional doses depend on response, maintenance: 0.04–0.07 mg/kg q 5–10 min as needed.
IV (Children): 1–2 mg/kg, up to 150 mg; additional doses depend on response, maintenance: 0.3–0.6 mg/kg q 5–10 min as needed, (continuous infusion not recommended in children or neonates because of the risk of malignant hyperthermia).

Prolonged Procedures

IV (Adults): 2.5 mg/min infusion (range 0.5–10 mg/min).

Intramuscular Dosing

IM (Adults and Children): Up to 3 — 4 mg/kg (total dose not to exceed 150 mg).

Implementation ⬆ ⬇

High Alert:Unplanned administration of a neuromuscular blocking agent instead of administration of the intended medication, or administration of a neuromuscular blocking agent in the absence of ventilatory support has resulted in serious harm and death. Watch for packaging similarities and double check for correct medication and dose.
Succinylcholine has no effect on consciousness or the pain threshold. Adequate anesthesia should always be used when succinylcholine is used as an adjunct to surgical procedures or when painful procedures are performed. To avoid patient distress, administer after unconsciousness has been achieved. Benzodiazepines and/or analgesics should be administered concurrently when prolonged succinylcholine therapy is used for ventilator patients because patient is awake and able to feel all sensations.
- If eyes remain open throughout prolonged administration, protect corneas with artificial tears.
- To prevent excessive salivation, patients may be premedicated with atropine or scopolamine.
- A small dose of a nondepolarizing agent may be used before succinylcholine to decrease the severity of muscle fasciculations.
- When used prior to electroconvulsive therapy, shock should be administered 1 min after administration.
IM: If IM route is used, administer deep into the deltoid muscle.

IV Administration:

IV: A test dose of 5–10 mg or 0.1 mg/kg may be administered to determine patient’s sensitivity and recovery time.
IV Push:
Rate: Usual adult dose is administered over 10–30 sec. Dose is titrated to patient response.
Continuous Infusion:
Rate: Administer at a rate of 0.5–10 mg/min; usual rate is 2.5–4.3 mg/min. Titrate dose to patient response and degree of paralysis required.
Y-Site Compatibility:
- acyclovir
- alfentanil
- alemtuzumab
- amikacin
- aminocaproic acid
- aminophylline
- amphotericin B lipid complex
- anidulafungin
- argatroban
- asorbic acid
- atracurium
- atropine
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- carboplatin
- caspofungin
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- cisplatin
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- dexamethasone
- dexmedetomidine
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxycycline
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etomidate
- etoposide
- etoposide phosphate
- famotidine
- fenoldopam
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- furosemide
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- heparin
- hetastarch
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- mechlorethamine
- meperidine
- metaraminol
- methotrexate
- methoxamine
- methyldopate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- miconazole
- midazolam
- milrinone
- minocycline
- mitoxantrone
- morphine
- multivitamins
- mycophenolate
- nalbuphine
- naloxone
- nesiritide
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- papaverine
- pemetrexed
- pentamidine
- pentazocine
- phentolamine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- protamine
- pyridoxime
- quinupristin/dalfopristin
- ranitidine
- sodium acetate
- streptokinase
- sufentanil
- tacrolimus
- teniposide
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- tolazoline
- trimetaphan
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vincristine
- vinorelbine
- vitamin B complex with C
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B colloidal
- azathioprine
- dantrolene
- diazepam
- diazoxide
- ganciclovir
- indomethacin
- nafcillin
- oxacillin
- penicillin G
- pentobarbital
- phenobarbital
- phenytoin
- sodium bicarbonate
- thiopental
- trimethoprim/sulfamethoxazole

US Brand Names ⬆ ⬇

Classifications ⬆ ⬇

Therapeutic Classification: neuromuscular blocking agents-depolarizing

Availability ⬆ ⬇

Injection: 20 mg/mL; 100 mg/mL;

Time/Action Profile ⬆ ⬇

(skeletal muscle paralysis)

ROUTE	ONSET	PEAK	DURATION
IM	up to 3 min	unknown	10–30 min
IV	0.5–1 min	1–2 min	4–10 min

Assessment ⬆ ⬇

Assess respiratory status continuously throughout use of succinylcholine. Succinylcholine should be used only by individuals experienced in endotracheal intubation, and equipment for this procedure should be immediately available.
Monitor neuromuscular response to succinylcholine with a peripheral nerve stimulator intraoperatively. Paralysis is initially selective and usually occurs consecutively in the following muscles: levator muscles of eyelids, muscles of mastication, limb muscles, abdominal muscles, muscles of the glottis, intercostal muscles, and the diaphragm.
Monitor ECG, heart rate, and BP throughout use of succinylcholine.
Assess patient for history of malignant hyperthermia before administration. Monitor for signs of malignant hyperthermia (tachycardia, tachypnea, hypercarbia, jaw muscle spasm, lack of laryngeal relaxation, hyperthermia) throughout administration.
Observe patient for residual muscle weakness and respiratory distress during the recovery period.

Lab Test Considerations:

May cause hyperkalemia, especially in patients with severe trauma, burns, or neurologic disorders.

Toxicity and Overdose:

If overdose occurs, use peripheral nerve stimulator to determine degree of neuromuscular blockade. Maintain airway patency and ventilation until recovery of normal respirations occurs.

Pot. Nursing Diagnoses ⬆ ⬇

Ineffective breathing pattern (Indications).
Impaired verbal communication (Side Effects).

Patient/Family Teaching ⬆ ⬇

Explain all procedures to patient receiving succinylcholine therapy without anesthesia, because consciousness is not affected by succinylcholine alone. Provide emotional support.
Reassure patient that communication abilities will return as the medication wears off.

Evaluation/Desired Outcomes ⬆ ⬇

Adequate suppression of the twitch response when tested with peripheral nerve stimulation, with subsequent muscle paralysis.

Code ⬆

NDC Code^*

0409- Hospira, Inc.
0409-6629- QUELICIN 0409-6629-02- 25 VIAL, MULTI-DOSE in 1 TRAY (0409-6629-02) > 10 mL in 1 VIAL, MULTI-DOSE (0409-6629-12)

0409- Hospira, Inc.
0409-6629- QUELICIN 0409-6629-25- 25 VIAL, MULTI-DOSE in 1 TRAY (0409-6629-25) > 10 mL in 1 VIAL, MULTI-DOSE (0409-6629-35)

0781- Sandoz Inc
0781-3411- Anectine 0781-3411-95- 10 VIAL, MULTI-DOSE in 1 CARTON (0781-3411-95) > 10 mL in 1 VIAL, MULTI-DOSE (0781-3411-70)

0781- Sandoz Inc
0781-9053- Anectine 0781-9053-95- 10 VIAL, MULTI-DOSE in 1 CARTON (0781-9053-95) > 10 mL in 1 VIAL, MULTI-DOSE (0781-9053-70)

49396- Renaissance Lakewood LLC
49396-0152- Succinylcholine Chloride 49396-0152-2- 6 CARTON in 1 BOX (49396-0152-2) > 25 VIAL in 1 CARTON > 10 mL in 1 VIAL

51662- HF Acquisition Co LLC, DBA HealthFirst
51662-1353- SUCCINYLCHOLINE CHLORIDE 51662-1353-1- 10 mL in 1 VIAL, MULTI-DOSE (51662-1353-1)

52584- General Injectables and Vaccines, Inc.
52584-097- SUCCINYLCHOLINE CHLORIDE 52584-097-01- 1 VIAL, MULTI-DOSE in 1 BAG (52584-097-01) > 10 mL in 1 VIAL, MULTI-DOSE

52584- General Injectables and Vaccines, Inc.
52584-377- SUCCINYLCHOLINE CHLORIDE 52584-377-01- 1 VIAL, MULTI-DOSE in 1 BAG (52584-377-01) > 10 mL in 1 VIAL, MULTI-DOSE

69918- Amring Pharmaceuticals Inc.
69918-700- Succinylcholine Chloride 69918-700-25- 25 VIAL, MULTI-DOSE in 1 CARTON (69918-700-25) > 10 mL in 1 VIAL, MULTI-DOSE (69918-700-01)

70121- Amneal Biosciences LLC
70121-1581- SUCCINYLCHOLINE CHLORIDE 70121-1581-5- 25 VIAL, MULTI-DOSE in 1 CARTON (70121-1581-5) > 10 mL in 1 VIAL, MULTI-DOSE (70121-1581-1)

70710- Zydus Pharmaceuticals (USA) Inc.
70710-1377- Succinylcholine Chloride 70710-1377-2- 25 VIAL, MULTI-DOSE in 1 TRAY (70710-1377-2) > 10 mL in 1 VIAL, MULTI-DOSE (70710-1377-1)

70771- Cadila Healthcare Limited
70771-1352- Succinylcholine Chloride 70771-1352-7- 25 VIAL, MULTI-DOSE in 1 TRAY (70771-1352-7) > 10 mL in 1 VIAL, MULTI-DOSE (70771-1352-1)

71872- Medical Purchasing Solutions, LLC
71872-7026- Quelicin 71872-7026-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7026-1) > 10 mL in 1 VIAL, MULTI-DOSE

71872- Medical Purchasing Solutions, LLC
71872-7146- Quelicin 71872-7146-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7146-1) > 10 mL in 1 VIAL, MULTI-DOSE

71872- Medical Purchasing Solutions, LLC
71872-7166- SUCCINYLCHOLINE CHLORIDE 71872-7166-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7166-1) > 10 mL in 1 VIAL, MULTI-DOSE

71872- Medical Purchasing Solutions, LLC
71872-7167- Succinylcholine Chloride 71872-7167-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7167-1) > 1 mL in 1 VIAL, MULTI-DOSE

section name header

Pronunciation ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Contraind./Precautions ⬆ ⬇