Suxamethonium chloride

Suxamethonium chloride
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

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Black Box Warning

Risk Of Cardiac Arrest From Hyperkalemic Rhabdomyolysis See full prescribing information for complete Boxed Warning. There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. This syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes after the administration of the drug in healthy appearing children (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents. Therefore, when a healthy appearing infant or child develops cardiac arrest soon after administration of succinylcholine not felt to be due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include administration of intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation. Due to the abrupt onset of this syndrome, routine resuscitative measures are likely to be unsuccessful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some reported cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently. Since there may be no signs or symptoms to alert the practitioner to which patients are at risk, it is recommended that the use of succinylcholine in children 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 intramuscular use when a suitable vein is inaccessible (see Precautions: Pediatric Use and Dosage and administration).

Overview

Suxamethonium chloride is a skeletal muscle relaxant, neuromuscular blocking drug that is FDA approved for the {{{indicationType}}} of induction of neuromuscular blockade, adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation, rapid sequence intubation. There is a Black Box Warning for this drug as shown here. Common adverse reactions include ophthalmic: raised intraocular pressure.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Induction of neuromuscular blockade, Adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation

• Short procedures, 0.6 mg/kg IV (range 0.3 to 1.1 mg/kg) over 10 to 30 seconds
• Long procedures, 2.5 to 4.3 mg/min continuous IV infusion
• Long procedures, 0.3 to 1.1 mg/kg IV initially followed by 0.04 to 0.07 mg/kg at appropriate intervals
• 3 to 4 mg/kg IM, if suitable vein is inaccessible; MAX 150 mg
• Rapid sequence intubation: 1.5 mg/kg IV push

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

• Electroconvulsive therapy; Adjunct

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Suxamethonium chloride in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

due to risk of cardiac arrest from hyperkalemic rhabdomyolysis, use in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary [1] Induction of neuromuscular blockade, Adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation: emergency tracheal intubation, infants and small pediatric patients, 2 mg/kg IV [1][4][5] Induction of neuromuscular blockade, Adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation: emergency tracheal intubation, older pediatric patients and adolescents, 1 mg/kg [1][4][5] Induction of neuromuscular blockade, Adjunct to general anesthesia, to facilitate endotracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation: 3 to 4 mg/kg IM, if suitable vein is inaccessible; MAX 150 mg [1] Rapid sequence intubation: older children and adolescents, 1 mg/kg IV [4][5][1] Rapid sequence intubation: infants and small children, 2 mg/kg IV

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Suxamethonium chloride in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Suxamethonium chloride in pediatric patients.

Contraindications

There is limited information regarding Suxamethonium chloride Contraindications in the drug label.

Warnings

Risk Of Cardiac Arrest From Hyperkalemic Rhabdomyolysis See full prescribing information for complete Boxed Warning. There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. This syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes after the administration of the drug in healthy appearing children (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents. Therefore, when a healthy appearing infant or child develops cardiac arrest soon after administration of succinylcholine not felt to be due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include administration of intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation. Due to the abrupt onset of this syndrome, routine resuscitative measures are likely to be unsuccessful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some reported cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently. Since there may be no signs or symptoms to alert the practitioner to which patients are at risk, it is recommended that the use of succinylcholine in children 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 intramuscular use when a suitable vein is inaccessible (see Precautions: Pediatric Use and Dosage and administration).

There is limited information regarding Suxamethonium chloride Warnings' in the drug label.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Suxamethonium chloride Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Suxamethonium chloride Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Suxamethonium chloride Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Suxamethonium chloride in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Suxamethonium chloride in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Suxamethonium chloride during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Suxamethonium chloride in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Suxamethonium chloride in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Suxamethonium chloride in geriatric settings.

Gender

There is no FDA guidance on the use of Suxamethonium chloride with respect to specific gender populations.

Race

There is no FDA guidance on the use of Suxamethonium chloride with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Suxamethonium chloride in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Suxamethonium chloride in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Suxamethonium chloride in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Suxamethonium chloride in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Suxamethonium chloride Administration in the drug label.

Monitoring

There is limited information regarding Suxamethonium chloride Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Suxamethonium chloride and IV administrations.

Overdosage

There is limited information regarding Suxamethonium chloride overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Suxamethonium chloride Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Suxamethonium chloride Mechanism of Action in the drug label.

Structure

There is limited information regarding Suxamethonium chloride Structure in the drug label.

Pharmacodynamics

There is limited information regarding Suxamethonium chloride Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Suxamethonium chloride Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Suxamethonium chloride Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Suxamethonium chloride Clinical Studies in the drug label.

How Supplied

There is limited information regarding Suxamethonium chloride How Supplied in the drug label.

Storage

There is limited information regarding Suxamethonium chloride Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Suxamethonium chloride Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Suxamethonium chloride interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Suxamethonium chloride Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Suxamethonium chloride Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.