Suxamethonium Chloride

Registered South African indications:

• Muscle relaxation

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Patients who have suffered burns, massive trauma, exhibit myotonia and muscular rigidity, hemiplegia, paraplegia, muscular denervation, and muscular dystrophies
• Family history of malignant hyperthermia
• Renal impairment with raised plasma-potassium concentration, severe long-lasting sepsis, or severe hyperkalaemia
• Glaucoma, penetrating wounds of the eye, or when the globe is open or after initial surgery in massively traumatised patients
• Patients known to have atypical pseudocholinesterase
• Patients with low serum-pseudocholinesterase concentrations, as may occur in:
  • Liver disease
  • Malnutrition
  • Severe anaemia
  • Cancer
  • Collagen diseases
  • Severe dehydration
  • Severe infections
  • Myocardial infarctions
  • Myxoedema
  • Renal impairment
  • Exposure to organophosphate insecticides or weed killers
• Advanced myasthenia gravis, neurological defects, or phaeochromocytoma

Cautions

• Pregnancy
• Breastfeeding
• Severe hepatic impairment
• Tetanus
• Tuberculosis
• Severe infections
• Chronic debilitating disease
• Malignancy
• Chronic anaemia
• Malnutrition
• Auto-immune disease
• Plasma exchange
• Plasmapheresis
• Cardiopulmonary bypass
• Severe sepsis

Forms avail. in SA and covered in this monograph: inj

Muscle relaxation
- Endotracheal intubation, bronchoscopy, oesophagoscopy
- Orthopaedic conditions to assist reduction of dislocation or alignment of fractures
- Surgical manipulation

• IV: 1-2mg/kg, as a single dose

Paed. forms avail. in SA and covered in this monograph: inj

Muscle relaxation
- Endotracheal intubation, bronchoscopy, oesophagoscopy
- Orthopaedic conditions to assist reduction of dislocation or alignment of fractures
- Surgical manipulation

Younger than 1 year

• IV: 2mg/kg, as a single dose

Older than 1 year

• See adult dosage

Pregnancy

• Caution
• No studies of the effect of suxamethonium on pregnancy have been performed.  Suxamethonium has no direct action on the uterus or other smooth muscle structures. In normal therapeutic doses, it does not cross the placental barrier in sufficient amounts to affect the respiration of the infant. The benefits of the use of suxamethonium as part of a rapid sequence induction for general anaesthesia normally outweigh the possible risk to the foetus
• Plasma cholinesterase levels fall during the first trimester of pregnancy to about 70 to 80% of their pre-pregnancy values; a further fall to about 60 to 70% of the pre-pregnancy levels occurs within 2 to 4 days after delivery. Plasma cholinesterase levels then increase to reach normal over the next 6 weeks. Consequently, a high proportion of pregnant and puerperal patients may exhibit mildly prolonged neuromuscular blockade following suxamethonium injection

Breastfeeding

• Caution
• It is not known whether suxamethonium or its metabolites are excreted in human milk. Caution should be exercised when administering succinylcholine to breastfeeding women

Renal Impairment

• Renal impairment with a raised plasma-potassium concentration: Contraindicated

Hepatic Impairment

• Mild to moderate: No dose adjustment recommended
• Severe: Caution; no dose adjustment recommended

 Elderly

• No dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

•  Permitted - No warnings

Cardiovascular Disorders

• Hypertension
• Hypotension
• Bradycardia
• Tachycardia
• Arrhythmias
• Cardiac arrest

Respiratory Disorders

• Bronchospasm
• Prolonged respiratory depression
• Apnoea

Gastrointestinal Disorders

• Excessive salivation
• Increased intragastric pressure

Endocrine and Metabolic Disorders

• Transient increase in serum potassium

Musculoskeletal Disorders

• Malignant hyperthermia
• Rhabdomyolysis
• Trismus
• Myoglobinaemia
• Myoglobinuria
• Muscle fasciculation
• Post-operative muscle pains

Skin and Subcutaneous Tissue Disorders

• Rash

Immune, Blood and Lymphatic System Disorders

• Anaphylaxis

Sensory Disorders

• Increased intraocular pressure

• Organophosphate insecticides
• Ecothiopate eye drops
• Trimetaphan
• Anticholinesterase agents
• Cytotoxic compounds
• Psychiatric agents
• Anaesthetic agents
• Selective serotonin reuptake inhibitors
• Aprotinin
• Diphenhydramine
• Promethazine
• Oestrogens
• Oxytocin
• High dose steroids
• Oral contraceptives
• Terbutaline
• Metoclopramide
• Magnesium salts
• Lithium carbonate
• Azathioprine
• Quinine
• Aminoglycosides
• Clindamycin
• Polymyxins
• Antiarrhythmic agents
• Volatile anaesthetic agents
• Digoxin

None routine. Specific cases may require

• Serum potassium
• Serum calcium

Suxamethonium chloride causes a persistent depolarization of the neuromuscular junction. This depolarization is caused by suxamethonium mimicking the effect of acetylcholine but without being rapidly hydrolysed by acetylcholinesterase. This depolarization leads to desensitization.

 Injection (per ml) 50mg

• Pharma-Q Suxamethonium Forte (Pharma-Q)
• Suxamethonium Chloride Fresenius (Bodene)