succinylcholine (Rx)

Brand and Other Names:Anectine, suxamethonium, more...Quelicin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
  • 100mg/mL

Neuromuscular Blockade

Load

  • 0.3-1.1 mg/kg IV x1 dose, OR  
  • 3-4 mg/kg IM x1 dose
  • Short Procedures: usually 0.6 mg/kg IV injection

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)
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Interactions

Interaction Checker

and succinylcholine

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              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.

              • 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.

              • pilocarpine ophthalmic

                pilocarpine ophthalmic 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.

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              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)

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              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; 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
              • 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
              • Successful outcome depends on recognition of early signs, such as jaw muscle spasm, acidosis, or generalized rigidity to initial administration of succinylcholine for tracheal intubation, or failure of tachycardia to respond to deepening anesthesia
              • 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 the dantrolene prescribing information for additional information about management of malignant hyperthermic crisis
              • 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
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              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.

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              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)

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              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

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              succinylcholine chloride injection
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              20 mg/mL vial
              succinylcholine chloride injection
              -
              20 mg/mL vial
              succinylcholine chloride injection
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              20 mg/mL vial
              succinylcholine chloride injection
              -
              20 mg/mL vial
              succinylcholine chloride injection
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              20 mg/mL vial
              succinylcholine chloride injection
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              20 mg/mL vial
              succinylcholine chloride injection
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              20 mg/mL vial
              Quelicin injection
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              20 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              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) 2021 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.

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              Formulary

              FormularyPatient Discounts

              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.

              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.

              Tier Description
              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.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.