Drug reference

Suxamethonium

Neuromuscular Blocker · Skeletal Muscle Relaxant

Also known as Suxamethonium chloride, Succinylcholine, Anectine, Quelicin

Neuromuscular BlockerSkeletal Muscle Relaxant

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

Mildly prolonged maternal neuromuscular blockade may occur.

FDA category + note

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Mechanism

Suxamethonium is a depolarizing neuromuscular blocking agent. It acts as an acetylcholine receptor agonist at the neuromuscular junction, causing initial depolarization and muscle fasciculations. Due to its resistance to rapid hydrolysis by acetylcholinesterase, it leads to prolonged depolarization of the motor end-plate, resulting in skeletal muscle paralysis.

Indications

Neuromuscular blockade for surgical proceduresRapid sequence intubation

Dosing

Hepatic adjustment: Caution advised, particularly in end-stage hepatic failure, due to increased risk of prolonged apnoea from reduced hepatic synthesis of plasma cholinesterase.

Pharmacokinetics

Onset

0.8-1.4 min

Duration

6-11 min

Metabolism

Hydrolysis by plasma cholinesterases

Side effects

Common

ArrhythmiasBradycardiaFlushingInvoluntary muscle contractionsMyoglobinaemiaMyoglobinuriaPost procedural muscle painRash

Serious

Apnoea
Cardiac arrest
Hypersensitivity
Malignant hyperthermia
Respiratory disorders
Trismus

Pregnancy & lactation

Pregnancy

Mildly prolonged maternal neuromuscular blockade may occur.

Lactation

Unlikely to be present in breast milk in significant amounts (ionised at physiological pH). Breastfeeding may be resumed once the mother has recovered from neuromuscular block.