Drug reference
Suxamethonium acts by mimicking acetylcholine at the neuromuscular junction but hydrolysis is much slower than for acetylcholine; depolarisation is therefore prolonged, resulting in neuromuscular blockade.
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Neuromuscular blockade (short duration) during surgery and intubation ▶BY INTRAVENOUS INJECTION ▶Adult: 1–1.5 mg/kg l UNLICENSED USE Doses of suxamethonium in BNF may differ from those in product literature.
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Hyperkalaemia. low plasma- cholinesterase activity (including severe liver disease). major trauma. neurological disease involving acute wasting of major muscle. personal or family history of congenital myotonic disease. personal or family history of malignant hyperthermia. prolonged immobilisation (risk of hyperkalaemia). severe burns. skeletal muscle myopathies (e.g. Duchenne muscular dystrophy)
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Cardiac disease. neuromuscular disease. raised intra-ocular pressure (avoid in penetrating eye injury). respiratory disease. severe sepsis (risk of hyperkalaemia) Burns (resistance can develop, increased doses may be required). cardiovascular disease (reduce rate of administration). electrolyte disturbances (response unpredictable). fluid disturbances (response Anaesthesia unpredictable). hypothermia (activity prolonged, lower doses required). myasthenia gravis (activity prolonged, lower doses required). neuromuscular disorders (response unpredictable)
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Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs.
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Should only be administered by, or under the direct supervision of, personnel experienced in its use. Non-depolarising neuromuscular blocking drugs should only be administered by, or under direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management.
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→Appendix 1: suxamethonium
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▶Common or very common Arrhythmias. bradycardia (may occur with repeated doses). flushing. muscle contractions involuntary. myoglobinaemia. myoglobinuria. post procedural muscle pain. rash ▶Rare or very rare Apnoea. cardiac arrest. hypersensitivity. malignant hyperthermia. respiratory disorders. trismus SIDE-EFFECTS, FURTHER INFORMATION Premedication with atropine reduces bradycardia associated with suxamethonium use. ▶Common or very common Flushing. hypotension ▶Uncommon Bronchospasm. hypersensitivity. skin reactions. tachycardia ▶Rare or very rare Circulatory collapse. muscle weakness (after prolonged use in intensive care). myopathy (after prolonged use in intensive care). shock
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Mildly prolonged maternal neuromuscular blockade may occur. Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts.
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Unlikely to be present in breast milk in significant amounts (ionised at physiological pH). Breast- feeding may be resumed once the mother recovered from neuromuscular block. Non-depolarising neuromuscular blocking drugs are ionised at physiological pH and are unlikely to be present in milk in significant amounts. Breast-feeding may be resumed once the mother has recovered from neuromuscular block. eiiii F above
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Manufacturer advises caution, particularly in end stage hepatic failure (increased risk of prolonged apnoea due to reduced hepatic synthesis of plasma cholinesterase).
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for injection Solution for injection ▶Suxamethonium chloride (Non-proprietary) Suxamethonium chloride 50 mg per 1 ml Suxamethonium chloride 100mg/2ml solution for injection ampoules | 10 ampoule P £28.80–£50.00 ▶Anectine (Aspen Pharma Trading Ltd) Suxamethonium chloride 50 mg per 1 ml Anectine 100mg/2ml solution for injection ampoules | 5 ampoule P £3.57 (Hospital only) NEUROMUSCULAR BLOCKING DRUGS › NON- DEPOLARISING Non-depolarising f neuromuscular blocking drugs
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1–1.5 mg/kg
First-line fragment. Read the complete Indications and Dose section above.
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