Quelicin (succinylcholine chloride)

Dosage of succinylcholine chloride is expressed in terms of the salt. The dosage must be carefully adjusted according to individual requirements and response. The use of a peripheral nerve stimulator is recommended during continuous IV infusion of the drug to avoid overdose, detect development of Phase II block, follow rate of recovery, and assess the effects of reversing agents.

Succinylcholine chloride usually is administered IV. For patients in whom a suitable vein is not accessible, the drug may be administered by IM injection.

Succinylcholine chloride is supplied in multiple-dose vials and single-dose prefilled syringes containing a 20 mg/mL solution. Unopened vials and prefilled syringes should be stored under refrigeration at 2-8degreesC, but may be kept at room temperature for up to 14 days without significant loss of potency.

Dilution of the 20 mg/mL solution is not required prior to IV or IM injection.

For prolonged procedures, the manufacturer states that succinylcholine chloride may be given by continuous IV infusion or intermittent IV injection. For continuous IV infusion, succinylcholine chloride usually is diluted to a concentration of 1-2 mg/mL with a compatible IV solution such as 5% dextrose injection or 0.9% sodium chloride injection. The 1-mg/mL concentration is usually preferred for optimum rate control. Diluted solutions of succinylcholine chloride may be stored under refrigeration at 2-8degreesC for up to 24 hours. Succinylcholine injections should not be admixed with alkaline (pH exceeding 8.5) solutions (e.g., barbiturates).

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

*Skeletal muscle myopathies.

*Known hypersensitivity to succinylcholine.

*After the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury.

*Known or suspected genetic susceptibility to malignant hyperthermia.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

Adverse reactions reported with succinylcholine include cardiac arrest, malignant hyperthermia, arrhythmias, bradycardia, tachycardia, hypertension, hypotension, hyperkalemia, prolonged respiratory depression, and apnea.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

Safety and effectiveness of succinylcholine have been established in pediatric patients from neonates to adolescents. However, because of the risk of ventricular dysrhythmias, cardiac arrest, and death from hyperkalemic rhabdomyolysis in pediatric patients, use of succinylcholine should be reserved for emergency intubation or instances where immediate securing of the airway is necessary (e.g., laryngospasm, difficult airway, full stomach, or for IM use when a suitable vein is inaccessible).

IV bolus administration of succinylcholine in pediatric patients may result in profound bradycardia or, rarely, asystole; this occurs more commonly among pediatric patients than adult patients.

The effective dose of succinylcholine in pediatric patients may be higher than predicted based on body weight dosing alone.

Available data from published case reports and case series over decades of use have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes with the use of succinylcholine during pregnancy.

Succinylcholine is commonly used during caesarean section to provide muscle relaxation. It is known to cross the placental barrier in an amount that is dependent on the concentration gradient between the maternal and fetal circulation. Apnea and flaccidity can occur in the newborn after repeated high doses of succinylcholine are administered to the mother, or in the presence of atypical plasma cholinesterase in the mother.

Plasma cholinesterase levels are decreased by approximately 24% during pregnancy and for several days postpartum; this can prolong the effect of succinylcholine. If succinylcholine is used during labor and delivery, there is a risk for prolonged apnea.

There are no data regarding the presence of succinylcholine or its metabolite in human or animal milk; the effects on the breast-fed child and effects on milk production are not known.

Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for succinylcholine and any potential adverse effects on the breast-fed infant from the drug or underlying maternal condition.

The manufacturer recommends cautious dose selection, usually starting at the low end of the dosage range, for geriatric patients, reflecting the greater frequency of decreased hepatic, renal, or cardiac function in this patient population.

Clinical studies of succinylcholine did not include sufficient numbers of patients >=65 years of age to determine whether they respond differently from younger patients. Other reported clinical experience has not identified differences in responses between geriatric and younger patients.

In general, select dosages cautiously in geriatric patients, usually starting at the low end of the dosage range because of the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy in this patient population.