Succinylcholine: Uses, Dosage, and Side Effects Overview

Summary of Key Points

Succinylcholine is a medication used to temporarily relax muscles, most commonly during surgeries or medical procedures such as intubation. It works rapidly and is often utilized in emergency situations or under anesthesia. While it is highly effective, it can cause side effects, so it must always be administered under the supervision of a healthcare professional. Be sure to consult your doctor before starting or adjusting your dose.

Names of Medication

US Brand Name: Anectine

Generic Name: Succinylcholine

The generic name is the official medical name of the drug, while the brand name is what the manufacturer calls it. The generic name is listed in parentheses.

Pharmacologic Category

Neuromuscular Blocker, Depolarizing

Other medications in this category include:

1. Rocuronium
2. Vecuronium
3. Cisatracurium

Succinylcholine Dosing

Succinylcholine is used in various medical settings to induce muscle relaxation. The appropriate dose depends on the specific condition being treated. Always follow your healthcare provider’s instructions and never adjust your dose without consulting them. If you have any questions, you can schedule a telemedicine appointment with one of our providers.

Muscle Paralysis

Indication: Succinylcholine is used to induce muscle paralysis during surgeries or procedures.

Adult Dose: 0.6 mg/kg IV (intravenous) as a single dose

Frequency: One-time dose, typically given just before the procedure

Intubation

Indication: Succinylcholine is commonly used to relax muscles for endotracheal intubation (inserting a breathing tube).

Adult Dose: 1 to 1.5 mg/kg IV as a single dose

Frequency: One-time dose, given just before intubation

Succinylcholine in Anesthesia

Indication: Succinylcholine is used to relax muscles during general anesthesia.

Adult Dose: 0.3 to 1.1 mg/kg IV as a single dose

Frequency: One-time dose, typically administered before surgery begins

Electroconvulsive Therapy (ECT)

Indication: Succinylcholine is used to prevent muscle contractions during ECT.

Adult Dose: 0.3 to 1 mg/kg IV as a single dose

Frequency: One-time dose, given just before the procedure

Rapid Sequence Intubation (RSI)

Indication: Succinylcholine is used in emergency settings for rapid sequence intubation.

Adult Dose: 1 to 1.5 mg/kg IV as a single dose

Frequency: One-time dose, given immediately before intubation

Surgical Procedures

Indication: Succinylcholine is used to relax muscles during various surgical procedures.

Adult Dose: 0.3 to 1.1 mg/kg IV as a single dose

Frequency: One-time dose, typically administered before the procedure

Trauma

Indication: Succinylcholine may be used in trauma cases requiring intubation or muscle relaxation.

Adult Dose: 1 to 1.5 mg/kg IV as a single dose

Frequency: One-time dose, given as needed during emergency care

Respiratory Failure

Indication: Succinylcholine can be used to facilitate intubation in patients experiencing respiratory failure.

Adult Dose: 1 to 1.5 mg/kg IV as a single dose

Frequency: One-time dose, given immediately before intubation

Neuromuscular Disorders

Indication: Succinylcholine is used with caution in patients with neuromuscular disorders for muscle relaxation.

Adult Dose: 0.3 to 1.1 mg/kg IV as a single dose

Frequency: One-time dose, typically administered before a procedure

Sepsis

Indication: Succinylcholine may be used in septic patients requiring intubation or muscle relaxation.

Adult Dose: 1 to 1.5 mg/kg IV as a single dose

Frequency: One-time dose, given as needed during emergency care

Dosage Forms and Strengths

Injection (IV): 20 mg/mL, 100 mg/mL

Administration Instructions

Succinylcholine is administered by a healthcare professional, typically through an intravenous (IV) injection. It works rapidly, usually within 30 to 60 seconds, and its effects last for a short period, around 5 to 10 minutes. Due to its fast onset and short duration, it is often used in emergency settings or during brief procedures. Always follow your healthcare provider’s instructions and never attempt to administer this medication on your own.

Succinylcholine Contraindications

A contraindication is a specific situation or condition where a certain medication should not be used because it may cause harm. If you have any of the conditions listed below, taking Succinylcholine may not be safe for you. Always consult your healthcare provider or one of our telemedicine providers before starting any new medication.

Personal or family history of malignant hyperthermia: Malignant hyperthermia is a severe reaction to certain drugs used during surgery, including Succinylcholine. If you or a family member have experienced this, Succinylcholine can trigger a dangerous increase in body temperature and muscle contractions.

Hyperkalemia (high potassium levels): Succinylcholine can cause a further increase in potassium levels, which may lead to life-threatening heart problems, such as arrhythmias or cardiac arrest.

Recent burns, trauma, or muscle injury: Patients with recent significant burns, trauma, or muscle damage are at higher risk for hyperkalemia when taking Succinylcholine, which can lead to serious complications.

Neuromuscular diseases (e.g., muscular dystrophy, ALS): These conditions can cause abnormal responses to Succinylcholine, leading to prolonged paralysis or dangerous potassium levels.

Severe sepsis: In patients with sepsis, Succinylcholine can exacerbate hyperkalemia, leading to serious heart complications.

Glaucoma or increased intraocular pressure: Succinylcholine can increase pressure inside the eye, which may worsen conditions like glaucoma.

Drug to Drug Interactions with Succinylcholine

Succinylcholine can interact with other medications, potentially leading to harmful effects. It is crucial to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some medications that may interact with Succinylcholine:

1. Aminoglycoside antibiotics (e.g., Gentamicin, Tobramycin): These antibiotics can intensify Succinylcholine’s muscle-relaxing effects, which may result in prolonged paralysis.
2. Quinidine (Quinidex): This antiarrhythmic drug may increase the risk of abnormal heart rhythms when used alongside Succinylcholine.
3. Beta-blockers (e.g., Metoprolol, Atenolol): These medications can heighten the risk of bradycardia (slow heart rate) when combined with Succinylcholine.
4. Calcium channel blockers (e.g., Amlodipine, Diltiazem): These drugs can enhance Succinylcholine’s effects, potentially leading to prolonged muscle relaxation.
5. Cholinesterase inhibitors (e.g., Donepezil, Neostigmine): These medications can interfere with the breakdown of Succinylcholine, prolonging its effects and increasing the likelihood of side effects.

Succinylcholine Use During Pregnancy

Is it safe to take Succinylcholine during pregnancy?

Succinylcholine is classified as a Category C drug by the FDA for use during pregnancy. This means that while no well-controlled studies have been conducted in pregnant women, animal studies have shown some potential risks. Succinylcholine may be used during pregnancy if the potential benefits outweigh the risks, such as in emergencies requiring rapid muscle relaxation for intubation or surgery. However, it is essential to discuss all risks and benefits with your healthcare provider before taking this medication while pregnant. If you are pregnant and need to explore your options, our telemedicine providers are available to help you make an informed decision.

Succinylcholine and Breastfeeding

Is it safe to take Succinylcholine while breastfeeding?

There is limited information on the use of Succinylcholine during breastfeeding. However, due to its rapid breakdown in the body, it is unlikely that significant amounts would pass into breast milk. If Succinylcholine is needed for a medical procedure, it is generally considered safe to continue breastfeeding afterward. As always, consult your healthcare provider to discuss any concerns about breastfeeding while taking this medication.

Estimated Cost of Succinylcholine

The cost of Succinylcholine can vary depending on the pharmacy and location. Without insurance, the estimated cost of a 30-day supply using a GoodRx coupon ranges from $20 to $50. Prices may fluctuate, so it is recommended to check with your local pharmacy for the most accurate pricing.

Possible Alternatives to Succinylcholine

For certain conditions, alternative treatments or lifestyle changes may help manage your symptoms. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Here are some alternatives for conditions commonly treated with Succinylcholine:

1. Muscle paralysis: Alternative muscle relaxants like Rocuronium or Vecuronium may be used. Your provider can help determine which option is best for your specific needs.
2. Intubation: Non-depolarizing neuromuscular blockers such as Cisatracurium or Rocuronium can be considered as alternatives to Succinylcholine for intubation.
3. Anesthesia: Depending on the type of surgery, other muscle relaxants or sedatives may be used. Your anesthesiologist will choose the best option based on your medical history and the procedure.
4. Electroconvulsive therapy (ECT): Alternatives to Succinylcholine for muscle relaxation during ECT include medications like Mivacurium or Atracurium.
5. Rapid sequence intubation (RSI): Rocuronium is a common alternative to Succinylcholine for RSI, especially in patients where Succinylcholine is contraindicated.
6. Surgical procedures: Other neuromuscular blocking agents, such as Pancuronium or Atracurium, may be used depending on the procedure and patient condition.
7. Trauma: In trauma cases where Succinylcholine is contraindicated, alternatives like Rocuronium may be considered for muscle relaxation during emergency procedures.
8. Respiratory failure: In cases of respiratory failure requiring intubation, non-depolarizing agents like Vecuronium may be used as alternatives to Succinylcholine.
9. Neuromuscular disorders: Patients with neuromuscular disorders may require alternative medications or treatments, such as non-depolarizing agents, to avoid the risks associated with Succinylcholine.
10. Sepsis: In patients with sepsis, non-depolarizing agents like Rocuronium may be safer alternatives to Succinylcholine due to the risk of hyperkalemia.

Recent Updates on Succinylcholine Research

Recent research on Succinylcholine has focused on improving patient safety and minimizing side effects. Studies are exploring the use of alternative neuromuscular blocking agents in patients at higher risk for complications, such as those with neuromuscular disorders or hyperkalemia. Additionally, ongoing research is investigating genetic factors that may predispose certain individuals to adverse reactions, such as malignant hyperthermia. These studies aim to provide more personalized treatment options and improve outcomes for patients requiring muscle relaxation during surgery or emergency procedures.

As new research emerges, it is important to stay informed about the latest developments. If you have any concerns about your treatment with Succinylcholine, our telemedicine providers are available to discuss your options and help you make the best decision for your health.

James Kingsley

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