pharmacopeia
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/api/v1/drug/succinylcholine

Boxed warning

WARNING: VENTRICULAR DYSRHYTHMIAS, CARDIAC ARREST, AND DEATH FROM HYPERKALEMIC RHABDOMYOLYSIS IN PEDIATRIC PATIENTS Acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death has occurred after the administration of succinylcholine to apparently healthy pediatric patients who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy [see Warnings and Precautions ( 5.1 )]. When a healthy appearing pediatric patient develops cardiac arrest within minutes after administration of succinylcholine chloride, 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 [see Warnings and Precautions ( 5.1 )] . Reserve the use of succinylcholine chloride in pediatric patients for emergency intubation or instances where immediate securing of the airway is necessary, e.g., laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible [see Warnings and Precautions ( 5.1 )] . WARNING: VENTRICULAR DYSRHYTHMIAS, CARDIAC ARREST, AND DEATH FROM HYPERKALEMIC RHABDOMYOLYSIS IN PEDIATRIC PATIENTS See full prescribing information for complete boxed warning .

Mechanism of action

Sourced from openFDA

Succinylcholine is a depolarizing neuromuscular blocker. As does acetylcholine, it combines with the cholinergic receptors of the motor end plate to produce depolarization.

Cholinergic Neuromuscular Nicotinic

Indications

Sourced from openFDA
  • Succinylcholine chloride injection is indicated in adults and pediatric patients: as an adjunct to general anesthesia to facilitate tracheal intubation to provide skeletal muscle relaxation during surgery or mechanical ventilation. Succinylcholine chloride is a depolarizing neuromuscular blocker indicated in adults and pediatric patients: as an adjunct to general anesthesia ( 1 ) to facilitate tracheal intubation ( 1 ) to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Contraindications

Sourced from openFDA
  • Succinylcholine chloride is contraindicated: in patients with skeletal muscle myopathies [see Warnings and Precautions ( 5.1 )] in patients with known hypersensitivity to succinylcholine.contraindicated

Dosage & administration

Sourced from openFDA

For intravenous or intramuscular use only. ( 2.1 ) Individualize dosage after careful assessment of the patient. ( 2.1 ) Accidental administration of neuromuscular blocking agents may be fatal. Store succinylcholine chloride injection with the cap and ferrule intact and in a manner that minimizes the possibility of selecting the wrong product. ( 2.1 ) See full prescribing information for succinylcholine chloride injection dosage recommendations, preparation instructions, and administration information. ( 2.2 , 2.3 , 2.4 , 2.5 , 2.6 ) 2.1 Important Dosage and Administration Information Succinylcholine chloride injection is for intravenous or intramuscular use only. Succinylcholine chloride injection must be titrated to effect by or under supervision of experienced clinicians who are familiar with its actions and with appropriate neuromuscular monitoring techniques. Succinylcholine chloride injection should be administered only by those skilled in the management of artificial respiration and only when facilities are instantly available for tracheal intubation and for providing adequate ventilation of the patient, including the administration of oxygen under positive pressure and the elimination of CO 2 . The clinician must be prepared to assist or control respiration. The dosage of succinylcholine chloride injection should be individualized and should always be determined by the clinician after careful assessment of the patient.

Warnings & precautions

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Anaphylaxis : Severe anaphylactic reactions to neuromuscular blocking agents, including succinylcholine, have been reported. Some cases have been life-threatening and fatal. Take necessary precautions, such as the immediate availability of appropriate emergency treatment. ( 5.2 ) Risk of Death due to Medication Errors : Unintended administration of succinylcholine chloride may result in paralysis, respiratory arrest and death. Confirm proper selection of intended product and avoid confusion with other injectable solutions that are present in critical care and other clinical settings. ( 5.3 ) Hyperkalemia : Succinylcholine chloride may induce serious cardiac arrhythmias or cardiac arrest due to hyperkalemia. ( 5.4 ) Malignant Hyperthermia: Malignant hyperthermia may occur, especially in individuals with known or suspected susceptibility based on genetic factors or family history. Discontinue triggering agents, administer intravenous dantrolene sodium, and apply supportive therapies. ( 5.5 ) Bradycardia : Intravenous bolus administration may result in profound bradycardia or, rarely, asystole. The incidence is higher following a second dose of succinylcholine. Pretreatment with anticholinergic agents (e.g., atropine) may reduce the occurrence of bradyarrhythmias.

Adverse reactions

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The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling: Ventricular Dysrhythmias, Cardiac Arrest, and Death from Hyperkalemic Rhabdomyolysis in Pediatric Patients [see Warnings and Precautions ( 5.1 )] Anaphylaxis [see Warnings and Precautions ( 5.2 )] Hyperkalemia [see Warnings and Precautions ( 5.4 )] Malignant Hyperthermia [see Warnings and Precautions ( 5.5 )] Bradycardia [see Warnings and Precautions ( 5.6 )] Increase in Intraocular Pressure [see Warnings and Precautions ( 5.7 )] Prolonged Neuromuscular Block due to Phase II Block and Tachyphylaxis [see Warnings and Precautions ( 5.8 )]. The following adverse reactions associated with the use of succinylcholine were identified in clinical studies or postmarketing reports.

Use in specific populations

Sourced from openFDA

8.1 Pregnancy Risk Summary Available data from published literature from case reports and case series over decades of use with succinylcholine during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Succinylcholine is used commonly during delivery by caesarean section to provide muscle relaxation. If succinylcholine is used during labor and delivery, there is a risk for prolonged apnea in some pregnant women (see Clinical Considerations). Animal reproduction studies have not been conducted with succinylcholine chloride. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations Maternal Adverse Reactions Plasma cholinesterase levels are decreased by approximately 24% during pregnancy and for several days postpartum which can prolong the effect of succinylcholine. Therefore, some pregnant patients may experience prolonged apnea.

Pharmacokinetics

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Metabolism
Elimination Succinylcholine levels were reported to be below the detection limit of 2 mcg/mL after 2.5 minutes of an intravenous bolus dose of 1 mg/kg or 2 mg/kg in 14 anesthetized patients. Metabolism Succinylcholine is rapidly hydrolyzed by plasma cholinesterase to succinylmonocholine (which possesses clinically insignificant depolarizing muscle relaxant properties) and then more slowly to succinic acid and choline .

Overdosage

Sourced from openFDA

Overdosage with succinylcholine chloride may result in neuromuscular block beyond the time needed for surgery and anesthesia. This may be manifested by skeletal muscle weakness, decreased respiratory reserve, low tidal volume, or apnea. The primary treatment is maintenance of a patent airway and respiratory support until recovery of normal respiration is assured. Depending on the dose and duration of succinylcholine chloride administration, the characteristic depolarizing neuromuscular block (Phase I) may change to a block with characteristics superficially resembling a non-depolarizing block (Phase II) [see Warnings and Precautions ( 5.8 )] .

Approval history

Sourced from openFDA
  • Aug 20, 1952NDANDA008453Sandoz
  • May 1, 1953NDANDA008845Hospira
  • May 4, 2018ANDAANDA209467Zydus Pharms
  • Jun 4, 2018ANDAANDA210231Amring Pharms
  • Nov 16, 2018ANDAANDA211432Amneal
  • Aug 2, 2019ANDAANDA210698Dr Reddys
  • Jan 15, 2020ANDAANDA211589Somerset Theraps Llc
  • May 4, 2020ANDAANDA213810Aspiro

FAERS reports

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Reference statistics only. FAERS reports are voluntarily submitted and are not incidence rates, safety signals, or causal evidence. Counts reflect reporting volume — how often a reaction was reported, not how often it occurs. For decision-grade use, consult openFDA and the FAERS Public Dashboard directly.
3,781 total reports matchedLatest report Share = reports listing the reaction ÷ total matched reports. Rows can sum to >100% because a single report often lists multiple reactions.
  1. 1Drug Ineffective43812%
  2. 2Hypotension3088.1%
  3. 3Hyperthermia Malignant2857.5%
  4. 4Cardiac Arrest2586.8%
  5. 5Drug Interaction2125.6%
  6. 6Anaphylactic Shock2095.5%
  7. 7Anaphylactic Reaction1824.8%
  8. 8Pain1393.7%
  9. 9Renal Failure1373.6%
  10. 10Maternal Exposure During Pregnancy1323.5%
  11. 11Rhabdomyolysis1283.4%
  12. 12Bradycardia1273.4%
  13. 13Foetal Exposure During Pregnancy1253.3%
  14. 14Anxiety1203.2%
  15. 15Renal Impairment1123.0%

Literature

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Recent PubMed references pinned to Succinylcholine as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

Clinical trials

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The 10 most recently updated of 94 ClinicalTrials.gov registrations naming Succinylcholine as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

Pharmacogenomics

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CPIC-curated drug–gene pairs for Succinylcholine. Levels describe the strength of curated evidence and guideline status — never a recommendation to test or to adjust therapy.

Frequently asked questions

How does Succinylcholine work?
Succinylcholine is a depolarizing neuromuscular blocker. As does acetylcholine, it combines with the cholinergic receptors of the motor end plate to produce depolarization.
What is Succinylcholine used for?
According to FDA labeling, Succinylcholine carries indications including: Succinylcholine chloride injection is indicated in adults and pediatric patients: as an adjunct to general anesthesia to facilitate tracheal intubation to provide skeletal muscle relaxation during surgery or mechanical ventilation. Succinylcholine chloride is a depolarizing neuromuscular blocker indicated in adults and pediatric patients: as an adjunct to general anesthesia ( 1 ) to facilitate tracheal intubation ( 1 ) to provide skeletal muscle relaxation during surgery or mechanical ventilation.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.
What class of drug is Succinylcholine?
Succinylcholine is classified as Choline derivatives, Depolarizing Neuromuscular Blocker, Cholinergic Neuromuscular Nicotinic Agonists, Decreased Striated Muscle Contraction, Neuromuscular Depolarizing Blockade.
What are the brand names for Succinylcholine?
Succinylcholine is marketed under brand names including Anectine, Quelicin.
What are the contraindications for Succinylcholine?
Succinylcholine labeling lists contraindications including: Succinylcholine chloride is contraindicated: in patients with skeletal muscle myopathies [see Warnings and Precautions ( 5.1 )] in patients with known hypersensitivity to succinylcholine.. Always consult the full prescribing information and a clinician.
Note. Data for succinylcholine is illustrative MVP content compiled from public sources. pharmacopeia is for educational and informational use only and is not a substitute for professional medical advice.

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