Pronunciation:

(suks in il KOE leen)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

>10%:

Ocular: Increased intraocular pressure

Miscellaneous: Postoperative stiffness

1% to 10%:

Cardiovascular: Bradycardia, hypotension, cardiac arrhythmia, tachycardia

Gastrointestinal: Intragastric pressure, salivation

<1%: Hypertension, rash, itching, erythema, hyperkalemia, myalgia, myoglobinuria, apnea, bronchospasm, circulatory collapse, malignant hyperthermia

Postmarketing and/or case reports: Acute quadriplegic myopathy syndrome (prolonged use), myositis ossificans (prolonged use)

Causes of prolonged neuromuscular blockade: Excessive drug administration; cumulative drug effect, decreased metabolism/excretion (hepatic and/or renal impairment); accumulation of active metabolites; electrolyte imbalance (hypokalemia, hypocalcemia, hypermagnesemia, hypernatremia); hypothermia; drug interactions; increased sensitivity to muscle relaxants (eg, neuromuscular disorders such as myasthenia gravis or polymyositis)

Overdosage/Toxicology:

Symptoms of overdose include respiratory paralysis and cardiac arrest.

Bradyarrhythmias can often be treated with atropine 0.1 mg (infants). Do not treat with anticholinesterase drugs (eg, neostigmine, physostigmine) since this may worsen its toxicity by interfering with its metabolism.

Drug Interactions:

Increased toxicity: Anticholinesterase drugs (neostigmine, physostigmine, or pyridostigmine) in combination with succinylcholine can cause cardiorespiratory collapse; cyclophosphamide, oral contraceptives, lidocaine, thiotepa, pancuronium, lithium, magnesium salts, aprotinin, chloroquine, metoclopramide, terbutaline, and procaine enhance and prolong the effects of succinylcholine

Prolonged neuromuscular blockade: Inhaled anesthetics; local anesthetics; calcium channel blockers; antiarrhythmics (eg, quinidine or procainamide); antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin); immunosuppressants (eg, cyclosporine)

Stability:

Refrigerate at 2°C to 8°C (36°F to 46°F); however, remains stable for 3 months unrefrigerated; powder form does not require refrigeration

Stability of parenteral admixture at refrigeration temperature (4°C): 24 hours in D5W or NS

I.V. form is incompatible when mixed with sodium bicarbonate, pentobarbital, thiopental

Compatibility:

Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D5¹/4NS, D5¹/2NS, D5NS, D5W, D10W, LR, ¹/2NS, NS

Y-site administration: Compatible: Etomidate, heparin with hydrocortisone sodium succinate, potassium chloride, propofol, vitamin B complex with C. Incompatible: Thiopental

Compatibility in syringe: Compatible: Heparin

Compatibility when admixed: Compatible: Amikacin, isoproterenol, meperidine, methyldopate, morphine, norepinephrine, scopolamine. Incompatible: Methohexital, nafcillin, sodium bicarbonate, thiopental. Variable (consult detailed reference): Pentobarbital

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: I.M.: 2-3 minutes; I.V.: Complete muscular relaxation: 30-60 seconds

Duration: I.M.: 10-30 minutes; I.V.: 4-6 minutes with single administration

Metabolism: Rapidly hydrolyzed by plasma pseudocholinesterase

Dosage:

I.M.: 2.5-4 mg/kg, total dose should not exceed 150 mg

I.V.:

Children: Initial: 1-2 mg/kg; maintenance: 0.3-0.6 mg/kg every 5-10 minutes as needed; because of the risk of malignant hyperthermia, use of continuous infusions is not recommended in infants and children

Adults: 1-1.5 mg/kg, up to 150 mg total dose

Maintenance: 0.04-0.07 mg/kg every 5-10 minutes as needed

Continuous infusion: 10-100 mcg/kg/minute (or 0.5-10 mg/minute); dilute to concentration of 1-2 mg/mL in D5W or NS

Note: Initial dose of succinylcholine must be increased when nondepolarizing agent pretreatment used because of the antagonism between succinylcholine and nondepolarizing neuromuscular blocking agents

Dosing adjustment in hepatic impairment: Dose should be decreased in patients with severe liver disease

Administration:

Monitoring Parameters:

Test Interactions:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

Critically-Ill Adult Patients: The 2002 ACCM/SCCM/ASHP clinical practice guidelines for sustained neuromuscular blockade in the adult critically-ill patient recommend:

Optimize sedatives and analgesics prior to initiation and monitor and adjust accordingly during course. Neuromuscular blockers do not relieve pain or produce sedation.

Protect patient's eyes from development of keratitis and corneal abrasion by administering ophthalmic ointment and taping eyelids closed or using eye patches. Reposition patient routinely to protect pressure points from breakdown. Address DVT prophylaxis.

Concurrent use of a neuromuscular blocker and corticosteroids appear to increase the risk of certain ICU myopathies; avoid or administer the corticosteroid at the lowest dose possible. Reassess need for neuromuscular blocker daily.

Using daily drug holidays (stopping neuromuscular-blocking agent until patient requires it again) may decrease the incidence of acute quadriplegic myopathy syndrome.

Tachyphylaxis can develop; switch to another neuromuscular blocker (taking into consideration the patient's organ function) if paralysis is still necessary.

Atracurium or cisatracurium is recommended for patients with significant hepatic or renal disease, due to organ-independent Hofmann elimination.

Monitor patients clinically and via "Train of Four" (TOF) testing with a goal of adjusting the degree of blockade to 1-2 twitches or based upon the patient's clinical condition.

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Injection, solution, as chloride: 20 mg/mL (10 mL) [may contain benzyl alcohol]

Anectine® [DSC]: 20 mg/mL (10 mL)

Quelicin®: 20 mg/mL (5 mL, 10 mL); 50 mg/mL (10 mL); 100 mg/mL (10 mL)

International Brand Names: