United States - English - NLM (National Library of Medicine)
SUCCINYLCHOLINE CHLORIDE- succinylcholine chloride injection, solution
Medical Purchasing Solutions, LLC
SUCCINYLCHOLINE CHLORIDE INJECTION, USP
A short-acting depolarizing skeletal muscle relaxant.
RISK OF CARDIAC ARREST FROM HYPERKALEMIC
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 pediatric patients 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 pediatric patients (usually, but not exclusively,
males, and most frequently 8 years of age or younger). There have also been reports in
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 pediatric patients 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).
This drug should be used only by individuals familiar with its actions, characteristics and
Succinylcholine Chloride Injection, USP is a sterile, nonpyrogenic solution to be used as an ultra short-
acting, depolarizing, skeletal muscle relaxant. See HOW SUPPLIED for summary of content and
characteristics of the solutions. The solutions are for intramuscular or intravenous use.
Succinylcholine Chloride, USP is chemically designated C
and its molecular weight
It has the following structural formula:
Succinylcholine is a diquaternary base consisting of the dichloride salt of the dicholine ester of
succinic acid. It is a white, odorless, slightly bitter powder, very soluble in water. The drug is
incompatible with alkaline solutions but relatively stable in acid solutions. Solutions of the drug lose
potency unless refrigerated.
Solution intended for multiple-dose administration contains 0.18% methylparaben and 0.02%
propylparaben as preservatives (List No. 6629). Product not requiring dilution (multiple-dose fliptop
vial) contains sodium chloride to render isotonic. May contain sodium hydroxide and/or hydrochloric
acid for pH adjustment. pH is 3.6 (3.0 to 4.5). See table in HOW SUPPLIED for characteristics.
Sodium Chloride, USP, chemically designated NaCl, is a white crystalline compound freely soluble in
Succinylcholine is a depolarizing skeletal muscle relaxant. As does acetylcholine, it combines with the
cholinergic receptors of the motor end plate to produce depolarization. This depolarization may be
observed as fasciculations. Subsequent neuromuscular transmission is inhibited so long as adequate
concentration of succinylcholine remains at the receptor site. Onset of flaccid paralysis is rapid (less
than one minute after intravenous administration), and with single administration lasts approximately 4 to
Succinylcholine is rapidly hydrolyzed by plasma cholinesterase to succinylmonocholine (which
possesses clinically insignificant depolarizing muscle relaxant properties) and then more slowly to
succinic acid and choline (see PRECAUTIONS). About 10% of the drug is excreted unchanged in the
urine. Succinylcholine levels were reported to be below the detection limit of 2 μg/mL after 2.5 minutes
of an intravenous bolus dose of 1 or 2 mg/kg in fourteen (14) anesthetized patients. The paralysis
following administration of succinylcholine is progressive, with differing sensitivities of different
muscles. This initially involves consecutively the levator muscles of the face, muscles of the glottis
and finally the intercostals and the diaphragm and all other skeletal muscles.
Succinylcholine has no direct action on the uterus or other smooth muscle structures. Because it is
highly ionized and has low fat solubility, it does not readily cross the placenta.
Tachyphylaxis occurs with repeated administration (see PRECAUTIONS).
Depending on the dose and duration of succinylcholine administration, the characteristic depolarizing
neuromuscular block (Phase I block) may change to a block with characteristics superficially
resembling a non-depolarizing block (Phase II block). This may be associated with prolonged
respiratory muscle paralysis or weakness in patients who manifest the transition to Phase II block. When
this diagnosis is confirmed by peripheral nerve stimulation, it may sometimes be reversed with
anticholinesterase drugs such as neostigmine (see PRECAUTIONS). Anticholinesterase drugs may not
always be effective. If given before succinylcholine is metabolized by cholinesterase,
anticholinesterase drugs may prolong rather than shorten paralysis.
Succinylcholine has no direct effect on the myocardium. Succinylcholine stimulates both autonomic
ganglia and muscarinic receptors which may cause changes in cardiac rhythm, including cardiac arrest.
Changes in rhythm, including cardiac arrest, may also result from vagal stimulation, which may occur
during surgical procedures, or from hyperkalemia, particularly in pediatric patients (see
PRECAUTIONS: Pediatric Use). These effects are enhanced by halogenated anesthetics.
Succinylcholine causes an increase in intraocular pressure immediately after its injection and during the
fasciculation phase, and slight increases which may persist after onset of complete paralysis (see
Succinylcholine may cause slight increases in intracranial pressure immediately after its injection and
during the fasciculation phase (see PRECAUTIONS).
As with other neuromuscular blocking agents, the potential for releasing histamine is present following
succinylcholine administration. Signs and symptoms of histamine mediated release such as flushing,
hypotension and bronchoconstriction are, however, uncommon in normal clinical usage.
Succinylcholine has no effect on consciousness, pain threshold or cerebration. It should be used only
with adequate anesthesia (see WARNINGS).
INDICATIONS AND USAGE
Succinylcholine chloride is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation,
and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Succinylcholine is contraindicated in persons with personal or familial history of malignant
hyperthermia, skeletal muscle myopathies and known hypersensitivity to the drug. It is also
contraindicated in patients after the acute phase of injury following major burns, multiple trauma,
extensive denervation of skeletal muscle, or upper motor neuron injury, because succinylcholine
administered to such individuals may result in severe hyperkalemia which may result in cardiac arrest
(see WARNINGS). The risk of hyperkalemia in these patients increases over time and usually peaks at 7
to 10 days after the injury. The risk is dependent on the extent and location of the injury. The precise
time of onset and the duration of the risk period are not known.
Succinylcholine should be used only by those skilled in the management of artificial respiration and
only when facilities are instantly available for tracheal intubation and for providing adequate ventilation
of the patient, including the administration of oxygen under positive pressure and the elimination of
carbon dioxide. The clinician must be prepared to assist or control respiration.
To avoid distress to the patient, succinylcholine should not be administered before unconsciousness has
been induced. In emergency situations, however, it may be necessary to administer succinylcholine
before unconsciousness is induced.
Succinylcholine is metabolized by plasma cholinesterase and should be used with caution, if at all, in
patients known to be or suspected of being homozygous for the atypical plasma cholinesterase gene.
Severe anaphylactic reactions to neuromuscular blocking agents, including succinylcholine, have been
reported. These reactions have, in some cases, been life-threatening and fatal. Due to the potential
severity of these reactions, the necessary precautions, such as the immediate availability of appropriate
emergency treatment, should be taken. Precautions should also be taken in those individuals who have
had previous anaphylactic reactions to other neuromuscular blocking agents since cross-reactivity
between neuromuscular blocking agents, both depolarizing and non-depolarizing, has been reported in
this class of drugs.
Risk of Death due to Medication Errors
Administration of Succinylcholine Chloride, USP results in paralysis, which may lead to respiratory
arrest and death; this progression may be more likely to occur in a patient for whom it is not intended.
Confirm proper selection of intended product and avoid confusion with other injectable solutions that
are present in critical care and other clinical settings. If another healthcare provider is administering the
product, ensure that the intended dose is clearly labeled and communicated.
Hyperkalemia: (see BOX WARNING) Succinylcholine should be administered with GREAT
CAUTION to patients suffering from electrolyte abnormalities and those who may have massive
digitalis toxicity, because in these circumstances succinylcholine may induce serious cardiac
arrhythmias or cardiac arrest due to hyperkalemia.
GREAT CAUTION should be observed if succinylcholine is administered to patients during the acute
phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or
upper motor neuron injury (see CONTRAINDICATIONS). The risk of hyperkalemia in these patients
increases over time and usually peaks at 7 to 10 days after the injury. The risk is dependent on the extent
and location of the injury. The precise time of onset and the duration of the risk period are
undetermined. Patients with chronic abdominal infection, subarachnoid hemorrhage, or conditions
causing degeneration of central and peripheral nervous systems should receive succinylcholine with
GREAT CAUTION because of the potential for developing severe hyperkalemia.
Malignant Hyperthermia: Succinylcholine administration has been associated with acute onset of
malignant hyperthermia, a potentially fatal hypermetabolic state of skeletal muscle. The risk of
developing malignant hyperthermia following succinylcholine administration increases with the
concomitant administration of volatile anesthetics. Malignant hyperthermia frequently presents as
intractable spasm of the jaw muscles (masseter spasm) which may progress to generalized rigidity,
increased oxygen demand, tachycardia, tachypnea and profound hyperpyrexia. Successful outcome
depends on recognition of early signs, such as jaw muscle spasm, acidosis, or generalized rigidity to
initial administration of succinylcholine for tracheal intubation, or failure of tachycardia to respond to
deepening anesthesia. Skin mottling, rising temperature and coagulopathies may occur later in the
course of the hypermetabolic process. Recognition of the syndrome is a signal for discontinuance of
anesthesia, attention to increased oxygen consumption, correction of acidosis, support of circulation,
assurance of adequate urinary output and institution of measures to control rising temperature.
Intravenous dantrolene sodium is recommended as an adjunct to supportive measures in the management
of this problem. Consult literature references and the dantrolene prescribing information for additional
information about the management of malignant hyperthermic crisis. Continuous monitoring of
temperature and expired CO
is recommended as an aid to early recognition of malignant hyperthermia.
Other: In both adults and pediatric patients the incidence of bradycardia, which may progress to
asystole, is higher following a second dose of succinylcholine. The incidence and severity of
bradycardia is higher in pediatric patients than adults. Whereas bradycardia is common in pediatric
patients after an initial dose of 1.5 mg/kg, bradycardia is seen in adults only after repeated exposure.
Pretreatment with anticholinergic agents (e.g., atropine) may reduce the occurrence of
Succinylcholine causes an increase in intraocular pressure. It should not be used in instances in which
an increase in intraocular pressure is undesirable (e.g., narrow angle glaucoma, penetrating eye injury)
unless the potential benefit of its use outweighs the potential risk.
Succinylcholine is acidic (pH = 3.5) and should not be mixed with alkaline solutions having a pH greater
than 8.5 (e.g., barbiturate solutions).
PRECAUTIONS: (SEE BOX WARNING)
General: When succinylcholine is given over a prolonged period of time, the characteristic
depolarization block of the myoneural junction (Phase I block) may change to a block with
characteristics superficially resembling a non-depolarizing block (Phase II block). Prolonged
respiratory muscle paralysis or weakness may be observed in patients manifesting this transition to
Phase II block. The transition from Phase I to Phase II block has been reported in 7 of 7 patients studied
under halothane anesthesia after an accumulated dose of 2 to 4 mg/kg succinylcholine (administered in
repeated, divided doses). The onset of Phase II block coincided with the onset of tachyphylaxis and
prolongation of spontaneous recovery. In another study, using balanced anesthesia (N
thiopental) and succinylcholine infusion, the transition was less abrupt, with great individual variability
in the dose of succinylcholine required to produce Phase II block. Of 32 patients studied, 24 developed
Phase II block. Tachyphylaxis was not associated with the transition to Phase II block, and 50% of the
patients who developed Phase II block experienced prolonged recovery.
When Phase II block is suspected in cases of prolonged neuromuscular blockade, positive diagnosis
should be made by peripheral nerve stimulation, prior to administration of any anticholinesterase drug.
Reversal of Phase II block is a medical decision which must be made upon the basis of the individual,
clinical pharmacology and the experience and judgment of the physician. The presence of Phase II
block is indicated by fade of responses to successive stimuli (preferably "train of four"). The use of an
anticholinesterase drug to reverse Phase II block should be accompanied by appropriate doses of an
anticholinergic drug to prevent disturbances of cardiac rhythm. After adequate reversal of Phase II
block with an anticholinesterase agent, the patient should be continually observed for at least 1 hour for
signs of return of muscle relaxation. Reversal should not be attempted unless: (1) a peripheral nerve
stimulator is used to determine the presence of Phase II block (since anticholinesterase agents will
potentiate succinylcholine-induced Phase I block), and (2) spontaneous recovery of muscle twitch has
been observed for at least 20 minutes and has reached a plateau with further recovery proceeding
slowly; this delay is to ensure complete hydrolysis of succinylcholine by plasma cholinesterase prior
to administration of the anticholinesterase agent. Should the type of block be misdiagnosed,
depolarization of the type initially induced by succinylcholine (i.e., Phase I block) will be prolonged by
an anticholinesterase agent.
Succinylcholine should be employed with caution in patients with fractures or muscle spasm because
the initial muscle fasciculations may cause additional trauma.
Succinylcholine may cause a transient increase in intracranial pressure; however, adequate anesthetic
induction prior to administration of succinylcholine will minimize this effect.
Succinylcholine may increase intragastric pressure, which could result in regurgitation and possible
aspiration of stomach contents.
Neuromuscular blockade may be prolonged in patients with hypokalemia or hypocalcemia.
Since allergic cross-reactivity has been reported in this class, request information from your patients
about previous anaphylactic reactions to other neuromuscular blocking agents. In addition, inform your
patients that severe anaphylactic reactions to neuromuscular blocking agents, including succinylcholine
have been reported.
Reduced Plasma Cholinesterase Activity: Succinylcholine should be used carefully in patients with
reduced plasma cholinesterase (pseudocholinesterase) activity. The likelihood of prolonged
neuromuscular block following administration of succinylcholine must be considered in such patients
(see DOSAGE AND ADMINISTRATION).
Plasma cholinesterase activity may be diminished in the presence of genetic abnormalities of plasma
cholinesterase (e.g., patients heterozygous or homozygous for atypical plasma cholinesterase gene),
pregnancy, severe liver or kidney disease, malignant tumors, infections, burns, anemia, decompensated
heart disease, peptic ulcer, or myxedema. Plasma cholinesterase activity may also be diminished by
chronic administration of oral contraceptives, glucocorticoids, or certain monoamine oxidase inhibitors
and by irreversible inhibitors of plasma cholinesterase (e.g., organophosphate insecticides,
echothiophate, and certain antineoplastic drugs).
Patients homozygous for atypical plasma cholinesterase gene (1 in 2500 patients) are extremely
sensitive to the neuromuscular blocking effect of succinylcholine. In these patients, a 5 to 10 mg test
dose of succinylcholine may be administered to evaluate sensitivity to succinylcholine, or
neuromuscular blockade may be produced by the cautious administration of a 1 mg/mL solution of
succinylcholine by slow intravenous infusion. Apnea or prolonged muscle paralysis should be treated
with controlled respiration.
Drug Interactions: Drugs which may enhance the neuromuscular blocking action of succinylcholine
include: promazine, oxytocin, aprotinin, certain non-penicillin antibiotics, quinidine, β-adrenergic
blockers, procainamide, lidocaine, trimethaphan, lithium carbonate, magnesium salts, quinine,
chloroquine, diethylether, isoflurane, desflurane, metoclopramide and terbutaline. The neuromuscular
blocking effect of succinylcholine may be enhanced by drugs that reduce plasma cholinesterase activity
(e.g., chronically administered oral contraceptives, glucocorticoids, or certain monoamine oxidase
inhibitors) or by drugs that irreversibly inhibit plasma cholinesterase (see PRECAUTIONS).
If other neuromuscular blocking agents are to be used during the same procedure, the possibility of a
synergistic or antagonistic effect should be considered.
Carcinogenesis, Mutagenesis, Impairment of Fertility: There have been no long-term studies
performed in animals to evaluate carcinogenic potential of succinylcholine. Genetic toxicology studies
have not been completed to evaluate the genotoxic potential of succinylcholine. There are no studies to
evaluate the potential impact of succinylcholine on fertility.
Risk Summary: It is also not known whether succinylcholine can cause fetal harm when administered to
a pregnant woman or can affect reproduction capacity. Animal reproduction studies have not been
conducted with succinylcholine chloride. Succinylcholine should be given to a pregnant woman only if
The estimated background risk of major birth defects and miscarriage for the indicated population is
unknown. All pregnancies have a background risk of birth defect, loss or other adverse outcomes. In the
U.S. general population, the estimated background risk of major birth defects and miscarriage in
clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinal Considerations: Plasma cholinesterase levels are decreased by approximately 24% during
pregnancy and for several days postpartum. Therefore, a higher proportion of patients may be expected
to show increased sensitivity (prolonged apnea) to succinylcholine when pregnant than when
Labor and Delivery: Succinylcholine is commonly used to provide muscle relaxation during delivery
by caesarean section. While small amounts of succinylcholine are known to cross the placental barrier,
under normal conditions the quantity of drug that enters fetal circulation after a single dose of 1 mg/kg
to the mother should not endanger the fetus. However, since the amount of drug that crosses the
placental barrier is dependent on the concentration gradient between the maternal and fetal circulations,
residual neuromuscular blockade (apnea and flaccidity) may occur in the newborn after repeated high
doses to, or in the presence of atypical plasma cholinesterase in, the mother.
Nursing Mothers: It is not known whether succinylcholine is excreted in human milk. Because many
drugs are excreted in human milk, caution should be exercised following succinylcholine administration
to a nursing woman.
Pediatric Use: Safety and effectiveness of succinylcholine chloride have been established in pediatric
patient age groups, neonate to adolescent. There are rare reports of ventricular dysrhythmias and
cardiac arrest secondary to acute rhabdomyolysis with hyperkalemia in apparently healthy pediatric
patients who receive succinylcholine (see BOX WARNING). Many of these pediatric patients were
subsequently found to have a skeletal muscle myopathy such as Duchenne’s muscular dystrophy whose
clinical signs were not obvious. The syndrome often presents as sudden cardiac arrest within minutes
after the administration of succinylcholine. These pediatric patients are usually, but not exclusively,
males, and most frequently 8 years of age or younger. There have also been reports in adolescents.
There may be no signs or symptoms to alert the practitioner to which patients are at risk. A careful
history and physical may identify developmental delays suggestive of a myopathy. A preoperative
creatine kinase could identify some but not all patients at risk. Due to the abrupt onset of this syndrome,
routine resuscitative measures are likely to be unsuccessful. Careful monitoring of the
electrocardiogram may alert the practitioner to peaked T-waves (an early sign). Administration of
intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation have resulted in
successful resuscitation in some of the reported cases. Extraordinary and prolonged resuscitative
efforts have been effective in some cases. In addition, in the presence of signs of malignant
hyperthermia, appropriate treatment should be initiated concurrently (see WARNINGS). Since it is
difficult to identify which patients are at risk, it is recommended that the use of succinylcholine in
pediatric patients 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.
As in adults, the incidence of bradycardia in pediatric patients is higher following the second dose of
succinylcholine. The incidence and severity of bradycardia is higher in pediatric patients than adults.
Pre-treatment with anticholinergic agents, e.g., atropine, may reduce the occurrence of
Geriatric Use: Clinical studies of Succinylcholine Chloride Injection did not include sufficient
numbers of subjects aged 65 and over to determine whether they respond differently from younger
subjects. Other reported clinical experience has not identified differences in responses between the
elderly and younger patients.
In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the
dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of
concomitant disease or other drug therapy.
Adverse reactions to succinylcholine consist primarily of an extension of its pharmacological actions.
Succinylcholine causes profound muscle relaxation resulting in respiratory depression to the point of
apnea; this effect may be prolonged. Hypersensitivity reactions, including anaphylaxis, may occur in
rare instances. The following additional adverse reactions have been reported: cardiac arrest, malignant
hyperthermia, arrhythmias, bradycardia, tachycardia, hypertension, hypotension, hyperkalemia,
prolonged respiratory depression or apnea, increased intraocular pressure, muscle fasciculation, jaw
rigidity, postoperative muscle pain, rhabdomyolysis with possible myoglobinuric acute renal failure,
excessive salivation, and rash.
There have been post-marketing reports of severe allergic reactions (anaphylactic and anaphylactoid
reactions) associated with use of neuromuscular blocking agents, including succinylcholine. These
reactions, in some cases, have been life threatening and fatal. Because these reactions were reported
voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency
(see WARNINGS and PRECAUTIONS).
Overdosage with succinylcholine may result in neuromuscular block beyond the time needed for
surgery and anesthesia. This may be manifested by skeletal muscle weakness, decreased respiratory
reserve, low tidal volume, or apnea. The primary treatment is maintenance of a patent airway and
respiratory support until recovery of normal respiration is assured. Depending on the dose and duration
of succinylcholine administration, the characteristic depolarizing neuromuscular block (Phase I) may
change to a block with characteristics superficially resembling a non-depolarizing block (Phase II) (see
DOSAGE AND ADMINISTRATION
The dosage of succinylcholine should be individualized and should always be determined by the
clinician after careful assessment of the patient (see WARNINGS).
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to
administration whenever solution and container permit. Solutions which are not clear and colorless
should not be used.
Risk of Medication Errors
Accidental administration of neuromuscular blocking agents may be fatal. Store Succinylcholine
Chloride Injection, USP with the cap and ferrule intact and in a manner that minimizes the possibility of
selecting the wrong product.
For Short Surgical Procedures: The average dose required to produce neuromuscular blockade and
to facilitate tracheal intubation is 0.6 mg/kg Succinylcholine Chloride Injection given intravenously.
The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults. Following
administration of doses in this range, neuromuscular blockade develops in about 1 minute; maximum
blockade may persist for about 2 minutes, after which recovery takes place within 4 to 6 minutes.
However, very large doses may result in more prolonged blockade. A 5 to 10 mg test dose may be used
to determine the sensitivity of the patient and the individual recovery time (see PRECAUTIONS).
For Long Surgical Procedures: The dose of succinylcholine administered by infusion depends upon
the duration of the surgical procedure and the need for muscle relaxation. The average rate for an adult
ranges between 2.5 and 4.3 mg per minute.
Solutions containing from 1 to 2 mg per mL succinylcholine have commonly been used for continuous
infusion. The more dilute solution (1 mg per mL) is probably preferable from the standpoint of ease of
control of the rate of administration of the drug and, hence, of relaxation. This intravenous solution
containing 1 mg per mL may be administered at a rate of 0.5 mg (0.5 mL) to 10 mg (10 mL) per minute to
obtain the required amount of relaxation. The amount required per minute will depend upon the
individual response as well as the degree of relaxation required. Avoid overburdening the circulation
with a large volume of fluid. It is recommended that neuromuscular function be carefully monitored
with a peripheral nerve stimulator when using succinylcholine by infusion in order to avoid overdose,
detect development of Phase II block, follow its rate of recovery, and assess the effects of reversing
agents (see PRECAUTIONS).
Intermittent intravenous injections of succinylcholine may also be used to provide muscle relaxation for
long procedures. An intravenous injection of 0.3 to 1.1 mg/kg may be given initially, followed, at
appropriate intervals, by further injections of 0.04 to 0.07 mg/kg to maintain the degree of relaxation
Pediatrics: For emergency tracheal intubation or in instances where immediate securing of the airway is
necessary, the intravenous dose of succinylcholine is 2 mg/kg for infants and small pediatric patients;
for older pediatric patients and adolescents the dose is 1 mg/kg (see BOX WARNING and
PRECAUTIONS: Pediatric Use). It is currently known that the effective dose of succinylcholine in
pediatric patients may be higher than that predicted by body weight dosing alone. For example, the usual
adult intravenous dose of 0.6 mg/kg is comparable to a dose of 2-3 mg/kg in neonates and infants to 6
months and 1-2 mg/kg in infants up to 2 years of age. This is thought to be due to the relatively large
volume of distribution in the pediatric patient versus the adult patient.
Rarely, intravenous bolus administration of succinylcholine in infants and pediatric patients may result in
malignant ventricular arrythmias and cardiac arrest secondary to acute rhabdomyolysis with
hyperkalemia. In such situations, an underlying myopathy should be suspected.
Intravenous bolus administration of succinylcholine in infants or pediatric patients may result in
profound bradycardia or, rarely, asystole. As in adults, the incidence of bradycardia in pediatric patients
is higher following a second dose of succinylcholine. Whereas bradycardia is common in pediatric
patients after an initial dose of 1.5 mg/kg, bradycardia is seen in adults only after repeated exposure.
The occurrence of bradyarrhythmias may be reduced by pretreatment with atropine (see
PRECAUTIONS: Pediatric Use).
Intramuscular Use: If necessary, succinylcholine may be given intramuscularly to infants, older
pediatric patients or adults when a suitable vein is inaccessible. A dose of up to 3 to 4 mg/kg may be
given, but not more than 150 mg total dose should be administered by this route. The onset of effect of
succinylcholine given intramuscularly is usually observed in about 2 to 3 minutes.
To prevent needle-stick injuries, needles should not be recapped, purposely bent, or broken by hand.
Succinylcholine Chloride Injection, USP is supplied as a clear, colorless solution in the following
concentrations and packages:
mg/mL mg (total)
mg/mL mg (total)
25 x Fliptop
Refrigeration of the undiluted agent will assure full potency until expiration date. All units carry a date
Store in refrigerator 2° to 8°C (36° to 46°F). The multi-dose vials are stable for up to 14 days at
room temperature without significant loss of potency.
Renaissance Pharmaceuticals Inc.
Lakewood, NJ 08701
Amring Pharmaceuticals Inc.
Berwyn, PA 19312
PRINCIPAL DISPLAY PANEL
Chloride Injection, USP
200 mg/10 mL (20 mg/mL)
WARNING: Paralyzing Agent
For Intravenous or Intramuscular Use
WARNING: Paralyzing Agent. Causes
Respiratory Arrest. Facilities must be
immediately available for artificial
10 mL Multiple-Dose Vial
NDC 71872-7167-1 Rx Only
Chloride Injection , USP
1 - 10 mL Multiple-Dose Vial
200 mg/10 mL (20 mg/mL)
WARNING: Paralyzing Agent
For Intravenous or Intramuscular Use
Store in refrigerator
2° to 8°C (36° to 46°F).
succinylcholine chloride injection, solution
Product T ype
HUMAN PRESCRIPTION DRUG
Ite m Code
(S ource )
NDC:718 72-716 7(NDC:6 9 9 18 -
70 0 )
Route of Administration
Active Ingredient/Active Moiety
Basis of Strength
Stre ng th
SUCCINYLCHO LINE CHLO RIDE (UNII: I9 L0 DDD30 I) (SUCCINYLCHOLINE -
UNII:J2R8 6 9 A8 YF)
in 1 mL
Stre ng th
METHYLPARABEN (UNII: A2I8 C7HI9 T)
1.8 mg in 1 mL
PRO PYLPARABEN (UNII: Z8 IX2SC1OH)
0 .2 mg in 1 mL
SO DIUM CHLO RIDE (UNII: 451W47IQ8 X)
SO DIUM HYDRO XIDE (UNII: 55X0 4QC32I)
Medical Purchasing Solutions, LLC
HYDRO CHLO RIC ACID (UNII: QTT1758 2CB)
WATER (UNII: 0 59 QF0 KO0 R)
NDC:718 72-716 7-
1 in 1 BAG
0 6 /19 /20 19
1 mL in 1 VIAL, MULTI-DOSE; Type 0 : No t a Co mbinatio n
Pro duc t
Marke ting Cate gory
Application Numbe r or Monograph Citation
Marke ting Start Date
Marke ting End Date
0 4/10 /20 19
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