SUXAMETHONIUM (SUCCINYLCHOLINE)

Depolarising neuromuscular blocking medicine

Dosage Forms

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Injection

50 mg/ml

Uses

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  • Brief muscular paralysis during endotracheal intubation, endoscopy and electroconvulsive therapy

Dose and Duration

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Neuromuscular blockade

Adult and child over 12 years: by IV injection, 1 mg/kg followed if necessary by supplements of 0.5–1 mg/kg at 5–10 minute intervals.
Or by IV infusion for prolonged procedures, 2.5–4 mg/minute of a solution of concentration of 1–2 mg/ml (max 500 mg/hour).

Child 1–12 years: by IV injection, 1 mg/kg followed if necessary by supplements of 0.5–1 mg/kg at 5–10 minute intervals.
Or by IM injection, up to 4 mg/kg (max 150 mg).

Neonate and child up to 1 year: by IV injection, 2 mg/kg.
Or by IM injection, up to 4–5 mg/kg.

Contra-indications

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  • Inability to maintain clear airway
  • Personal or family history of malignant hyperthermia
  • Hyperkalaemia
  • Major trauma
  • Neurological disease involving acute wasting of muscles
  • Prolonged immobilization
  • Personal or family history of congenital myotonic disease
  • Duchenne muscular dystrophy
  • Severe burns
  • Low plasma cholinesterase activity
  • Severe liver disease

Side Effects

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  • Post-operative pain
  • Myoglobinuria, myoglobinaemia
  • Prolonged apnoea
  • Increased intraocular pressure
  • Hyperkalaemia
  • Increased intra-gastric pressure
  • Flushing
  • Bradycardia, tachycardia
  • Malignant hyperthermia
  • Rash, anaphylactic reactions

Interactions

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  • Amikacin, clindamycin, vancomycin, polymixins (enhanced effects of suxamethonium)
  • Gentamicin, procainamide, streptomycin (enhanced muscle relaxant effect)
  • Paromomycin (enhanced effects of suxamethonium)
  • Propofol (increased risk of myocardial depression and bradycardia when given concomitantly)

Pregnancy

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  • Can be used

Breast-feeding

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  • Can be used

Storage

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  • Store between 2–8°C. Do not freeze. Protect from light.

⚠️ Caution

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  • Use with caution in hepatic impairment due to risk of prolonged apnoea in severe liver disease.
  • In pregnancy, suxamethonium may mildly prolong maternal paralysis.
  • Prolonged administration or high doses produce a phase II (dual) block associated with prolonged neuromuscular blockade and apnoea.
  • Continue assisted ventilation until muscle function is restored.
  • Use with caution in patients with history of sensitivity to other neuromuscular blocking medicines.