Anectine

Muscle Relaxants, Peripherally Acting

Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Do not mix succinylcholine with alkaline solutions; succinylcholine is acidic (pH 3 to 4.5) and may not be compatible with alkaline solutions having a pH more than 8.5 (e.g., barbiturate solutions).
Accidental administration of neuromuscular blocking agents can be fatal. Store succinylcholine with the cap and ferrule intact, in a manner that minimizes the possibility of selecting the wrong product.
Only experienced clinicians, familiar with the use of neuromuscular blocking drugs, should administer or supervise the use of succinylcholine. Adequacy of respiration must be assured through assisted or controlled ventilation.
To avoid distress to the patient, administer succinylcholine after unconsciousness has been induced; in emergent life-threatening situations, it may be necessary to administer succinylcholine before unconsciousness. Adequate amnesia, sedation, and analgesia should accompany neuromuscular blockade.
Pretreatment with anticholinergic agents (e.g., atropine) may reduce the occurrence of bradyarrhythmias.[42039]
Monitor heart rate, blood pressure, and oxygen saturation during neuromuscular blockade. Continuously monitor temperature and expired carbon dioxide to aid in early recognition of malignant hyperthermia. Monitor ECG; peaked T-waves are an early sign of cardiac arrest secondary to rhabdomyolysis and hyperkalemia.[42039] [44872]
Storage: Store in refrigerator at 2 to 8 degrees C (36 to 46 degrees F) until vial expiration date. Multi-dose vials (20 mg/mL) and prefilled syringes (20 mg/mL) are stable for up to 14 days at room temperature without significant loss of potency.[42039] Independent studies have produced inconsistent results, but generally, the drug appears to be stable in unopened vials for 2 months or more at room temperature. Succinylcholine 20 mg/mL and 50 mg/mL products from various manufacturers have been shown to retain at least 90% potency when stored unopened at room temperature for periods ranging from 2 to 8.3 months, depending on the specific product.[58491] [58492] [58495] These results should not be extrapolated to environments with variable temperatures (e.g., emergency transport vehicles), where 10% degradation times have been reported to be shorter (1 to 3 months).[58495] [58496] Undiluted succinylcholine chloride (20 mg/mL) was stable for 45 days at room temperature (25 degrees C) and 90 days refrigerated (4 degrees C) in 12 mL polypropylene syringes.[58493]
Updates for coronavirus disease 2019 (COVID-19): The FDA is allowing succinylcholine 20 mg/mL to be used beyond the labeled in-use time to help ensure access during COVID-related drug shortages. This period should be as short as possible, and for a maximum of 2 hours at room temperature or 4 hours when refrigerated. In-use time is defined as the maximum amount of time allowed to elapse between penetration of a closed-container system or after reconstitution of a lyophilized drug before patient administration.[65833]

Due to the risk for rhabdomyolysis and life-threatening hyperkalemia that has occurred in pediatric patients with unidentified myopathies, reserve succinylcholine use in pediatric patients for emergent situations when immediate securing of the airway is needed; intermittent IV infusions and continuous IV infusions are generally not recommended in pediatric patients.[42039]
 
Dilution
Succinylcholine supplied in single-dose vials (100 mg/mL) must be diluted before use. Succinylcholine supplied in multiple-dose vials (20 mg/mL) or prefilled syringes (20 mg/mL) do not require dilution before use.
Succinylcholine may be diluted to 1 mg/mL or 2 mg/mL in a solution such as 5% Dextrose Injection or 0.9% Sodium Chloride Injection.
Prepare diluted solution for single patient use only.
Storage: Store diluted solution in refrigerator at 2 to 8 degrees C (36 to 46 degrees F) and use within 24 hours of preparation. Discard unused portion.[42039]
 
IV Push
Administer via IV push.
 
Continuous IV Infusion
Monitor neuromuscular function with a peripheral nerve stimulator.[42039] [58502]

If necessary, succinylcholine may be administered intramuscularly to infants, older pediatric patients, or adults when intravenous access cannot be secured.
In patients with laryngospasm, relief of the spasm sufficient for effective bag-valve-mask ventilation should occur within 30 seconds of administration to allow for adequate ventilation until intubating conditions are achieved.
Inject deeply into a large muscle mass. Some experts recommend administration into the deltoid because the time to onset is typically more rapid than with administration into the quadriceps.

renal failure (unspecified) / Delayed / Incidence not known
cardiac arrest / Early / Incidence not known
hyperkalemia / Delayed / Incidence not known
rhabdomyolysis / Delayed / Incidence not known
myoglobinuria / Delayed / Incidence not known
asystole / Rapid / Incidence not known
bradycardia / Rapid / Incidence not known
bronchospasm / Rapid / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
angioedema / Rapid / Incidence not known
malignant hyperthermia / Rapid / Incidence not known
muscle paralysis / Delayed / Incidence not known
apnea / Delayed / Incidence not known
acute quadriplegic myopathy syndrome / Delayed / Incidence not known
thrombosis / Delayed / Incidence not known
keratitis / Delayed / Incidence not known
increased intracranial pressure / Early / Incidence not known
ocular hypertension / Delayed / Incidence not known

hypertension / Early / Incidence not known
erythema / Early / Incidence not known
sinus tachycardia / Rapid / Incidence not known
hypotension / Rapid / Incidence not known
wheezing / Rapid / Incidence not known
hypoxia / Early / Incidence not known
respiratory depression / Rapid / Incidence not known
myopathy / Delayed / Incidence not known
dyspnea / Early / Incidence not known
skin erosion / Delayed / Incidence not known
conjunctivitis / Delayed / Incidence not known
skin ulcer / Delayed / Incidence not known
tolerance / Delayed / Incidence not known

urticaria / Rapid / Incidence not known
rash / Early / Incidence not known
flushing / Rapid / Incidence not known
pruritus / Rapid / Incidence not known
weakness / Early / Incidence not known
xerophthalmia / Early / Incidence not known
anxiety / Delayed / Incidence not known
myalgia / Early / Incidence not known
hypersalivation / Early / Incidence not known

Succinylcholine is contraindicated in patients after the acute phase of injury after major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury. In such individuals, succinylcholine can cause severe hyperkalemia, which can result in serious cardiac arrhythmias and cardiac arrest. Risk of hyperkalemia increases over time and usually peaks 7 to 10 days after the injury; however, risk is dependent on the extent and location of injury, and the precise onset and duration of the risk period are unknown.[42039] Consider avoiding succinylcholine use or verify the patient's serum potassium concentration is within normal range before use in patients with electrolyte abnormalities, digitalis toxicity, chronic abdominal infections, subarachnoid hemorrhage, tetanus, disuse atrophy, Guillain-Barre syndrome, and degenerative nervous system disorders due to increased risk of developing severe hyperkalemia after succinylcholine administration in these patients.[42039] [52486] Do not use succinylcholine in any patient with a serum potassium of more than 5.5 mEq/L.[54427]

Succinylcholine is contraindicated in persons with skeletal muscle myopathy or known or suspected genetic susceptibility to malignant hyperthermia. Succinylcholine can induce malignant hyperthermia in persons with known or suspected susceptibility based on genetic factors or family history, including those with certain inherited ryanodine receptor (RYR1) or dihydropyridine receptor (CACNA1S) variants. Multiple pathogenic variants of RYR1 and CACNA1S genes have been associated with malignant hyperthermia susceptibility in persons receiving succinylcholine. Assess variant pathogenicity based on prior clinical experience, functional studies, prevalence information, or other evidence. Concomitant use of volatile anesthetics may further increase the risk of malignant hyperthermia. In neonates, infants, children, and adolescents, reserve the use of succinylcholine for emergency intubation or instances where immediate securing of the airway is necessary (e.g., laryngospasm, difficult airway, full stomach, or lack of intravenous access). There have been rare reports of ventricular dysrhythmias and fatal cardiac arrest secondary to rhabdomyolysis with hyperkalemia, primarily in healthy-appearing pediatric patients who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. Affected pediatric patients are typically, but not exclusively, males 8 years or younger. Although some patients have no identifiable risk factors, a careful history and physical exam may identify developmental delays suggestive of myopathy, and a preoperative creatinine kinase could identify patients at risk. Closely monitor body temperature, expired CO2, heart rate, blood pressure, and electrocardiogram in pediatric patients to help detect early signs of malignant hyperthermia and/or hyperkalemia. The rhabdomyolysis syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes of succinylcholine administration. If cardiac arrest occurs immediately after succinylcholine administration, institute immediate treatment for hyperkalemia (e.g., intravenous calcium, bicarbonate, glucose with insulin, hyperventilation). If malignant hyperthermia is suspected, initiate appropriate treatment (e.g., dantrolene, supportive care) concurrently.[42039]

Anectine, Quelicin

Rx

Parenteral, short-acting, depolarizing neuromuscular blocking agent (NMBA)
Used for an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation
Associated with histamine release and vagal stimulation

0.6 mg/kg/dose IV. Dosage range: 0.3 to 1.1 mg/kg. Onset of intubating conditions is about 1 minute.

3 to 4 mg/kg/dose (Max: 150 mg/dose) IM. Onset of intubating conditions is 2 to 3 minutes.[42039]

3 to 4 mg/kg/dose (Max: 150 mg/dose) IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [64934]

4 mg/kg/dose (Max: 150 mg/dose) IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [64934]

4 to 5 mg/kg/dose IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [64934]

2 to 4 mg/kg/dose IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [54427] [64934]

1.5 mg/kg/dose IV. Onset of intubating conditions is about 1 minute.

1 to 1.5 mg/kg/dose IV. Onset of intubating conditions is 30 to 60 seconds.[42039] [44771] [54428]

1 to 2 mg/kg/dose IV. Onset of intubating conditions is 30 to 60 seconds.

2 mg/kg/dose IV. Dosage range: 1 to 3 mg/kg/dose. Onset of intubating conditions is usually 30 to 60 seconds. May repeat 1 mg/kg/dose IV if intubating conditions are not attained within an adequate period (1 to 5 minutes). Max: 4 mg/kg per intubation attempt.

2 mg/kg/dose IV. Dosage range: 1 to 3 mg/kg/dose. Onset of intubating conditions is usually 30 to 60 seconds. May repeat 1 mg/kg/dose IV if intubating conditions are not attained within an adequate period (1 to 5 minutes). Max: 4 mg/kg per intubation attempt.

3 to 4 mg/kg/dose (Max: 150 mg/dose) IM. Onset of intubating conditions is 2 to 3 minutes. [44868]

3 to 4 mg/kg/dose (Max: 150 mg/dose) IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [64934]

4 mg/kg/dose (Max: 150 mg/dose) IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [64934]

4 to 5 mg/kg/dose IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [64934]

2 to 4 mg/kg/dose IM. Onset of intubating conditions is 2 to 5 minutes.[42039] [44872] [54427] [64934]

0.3 to 1.1 mg/kg/dose IV once, followed by 0.04 to 0.07 mg/kg/dose IV as needed; adjust dose and interval to patient's twitch response.

0.5 to 10 mg/minute continuous IV infusion; titrate to patient's twitch response. Usual dosage range: 2.5 to 4.3 mg/minute.

0.5 to 1.5 mg/kg/dose IV.

†Indicates off-label use

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

Acebutolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Acetazolamide: (Moderate) Nondepolarizing neuromuscular blockers when combined with carbonic anhydrase inhibitors may lead to prolonged respiratory depression. This action is due to enhanced neural blockade as a result of potential hypokalemia from the carbonic anhydrase inhibitor. Serum potassium concentrations should be checked and adjusted prior to the administration of nondepolarizing neuromuscular blockers.
Amide local anesthetics: (Moderate) Concomitant use of neuromuscular blockers and local anesthetics may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Aminoglycosides: (Moderate) Concomitant use of neuromuscular blockers and systemic aminoglycosides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Amlodipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amlodipine; Atorvastatin: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amlodipine; Benazepril: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amlodipine; Celecoxib: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amlodipine; Olmesartan: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amlodipine; Valsartan: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Amphotericin B lipid complex (ABLC): (Moderate) Monitor serum potassium concentrations with concomitant use of neuromuscular blockers and amphotericin B. Amphotericin B-induced hypokalemia may prolong neuromuscular blockade.
Amphotericin B liposomal (LAmB): (Moderate) Monitor serum potassium concentrations with concomitant use of neuromuscular blockers and amphotericin B. Amphotericin B-induced hypokalemia may prolong neuromuscular blockade.
Amphotericin B: (Moderate) Monitor serum potassium concentrations with concomitant use of neuromuscular blockers and amphotericin B. Amphotericin B-induced hypokalemia may prolong neuromuscular blockade.
Atenolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Atenolol; Chlorthalidone: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Atracurium: (Major) If succinylcholine is used before atracurium, delay atracurium administration until recovery from succinylcholine-induced neuromuscular blockade begins. With succinylcholine as the intubating agent, use an initial atracurium dose of 0.3 to 0.4 mg/kg for adults under balanced anesthesia. Prior administration of succinylcholine quickens the onset and may increase the depth of the neuromuscular block induced by atracurium. The time to maximum block by atracurium is decreased by 2 to 3 minutes with prior use of succinylcholine.
Bacitracin: (Minor) Concomitant use of neuromuscular blockers and systemic bacitracin may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Beta-blockers: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Betaxolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Bisoprolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Botulinum Toxins: (Moderate) Use neuromuscular blockers and botulinum toxins concurrently with caution because the effect of the botulinum toxin may be potentiated. If coadministered, observe the patient closely.
Brimonidine; Timolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Calcium Acetate: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Carbonate: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Carbonate; Magnesium Hydroxide: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Carbonate; Simethicone: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Chloride: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium Gluconate: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium; Vitamin D: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Calcium-channel blockers: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Capreomycin: (Minor) Concomitant use of neuromuscular blockers and capreomycin may prolong neuromuscular blockade. A partial neuromuscular blockade was demonstrated after large intravenous doses of capreomycin.
Carbonic anhydrase inhibitors: (Moderate) Nondepolarizing neuromuscular blockers when combined with carbonic anhydrase inhibitors may lead to prolonged respiratory depression. This action is due to enhanced neural blockade as a result of potential hypokalemia from the carbonic anhydrase inhibitor. Serum potassium concentrations should be checked and adjusted prior to the administration of nondepolarizing neuromuscular blockers.
Carteolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Carvedilol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Chloroquine: (Moderate) Concomitant use of succinylcholine and chloroquine may prolong neuromuscular blockade.
Chromium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Cisatracurium: (Moderate) The use of succinylcholine before cisatracurium administration may decrease the time to onset of maximum neuromuscular blockade but has no effect on the duration of neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Clevidipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Colistimethate, Colistin, Polymyxin E: (Moderate) Use neuromuscular blockers and polymyxins with extreme caution. Concomitant use of neuromuscular blockers and polymyxins may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Colistin: (Moderate) Use neuromuscular blockers and polymyxins with extreme caution. Concomitant use of neuromuscular blockers and polymyxins may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Corticosteroids: (Moderate) Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years.
Cyclophosphamide: (Major) Notify the anesthesiologist if a patient has been treated with cyclophosphamide within 10 days of general anesthesia. Cyclophosphamide treatment causes a marked and persistent inhibition of cholinesterase activity; prolonged apnea may occur with concurrent use of depolarizing muscle relaxants such as succinylcholine.
Cyclosporine: (Moderate) Concomitant use of neuromuscular blockers and cyclosporine may prolong neuromuscular blockade.
Demeclocycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Desflurane: (Moderate) Additional monitoring or a dosage reduction may be required for some patients during concomitant use of succinylcholine and desflurane. Concomitant use may prolong neuromuscular blockade and increase the risk for hyperkalemia and malignant hyperthermia. Anesthetic concentrations of desflurane at equilibrium (administered for 15 or more minutes before testing) reduced the effective dose (ED95) of succinylcholine by approximately 30% compared to nitrous oxide/opioid anesthesia.
Dextromethorphan; Quinidine: (Moderate) Concomitant use of neuromuscular blockers and quinidine may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Digoxin: (Moderate) Succinylcholine-induced potassium release from muscle cells may cause arrhythmias in patients receiving digoxin.
Diltiazem: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Donepezil: (Moderate) A synergistic effect may be expected when succinylcholine is given concomitantly with a cholinesterase inhibitor, such as donepezil.
Donepezil; Memantine: (Moderate) A synergistic effect may be expected when succinylcholine is given concomitantly with a cholinesterase inhibitor, such as donepezil.
Dorzolamide; Timolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Doxapram: (Minor) Doxapram may temporarily mask the residual effects of neuromuscular blockers.
Doxycycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Esmolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Ester local anesthetics: (Moderate) Concomitant use of neuromuscular blockers and local anesthetics may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Felodipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Folic Acid, Vitamin B9: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Fosphenytoin: (Moderate) Concomitant use of neuromuscular blockers and fosphenytoin may increase resistance to the neuromuscular blockade action of neuromuscular blockers, resulting in shorter durations of neuromuscular blockade and higher infusion rate requirements. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Galantamine: (Moderate) A synergistic effect may be expected when succinylcholine is given concomitantly with a cholinesterase inhibitor, such as galantamine.
Indapamide: (Moderate) Concomitant use of neuromuscular blockers and indapamide may prolong neuromuscular blockade, possibly due to hypokalemia or alterations in potassium concentrations across the end-plate membrane.
Irinotecan Liposomal: (Moderate) Concomitant use of succinylcholine and irinotecan may prolong neuromuscular blockade. Irinotecan has anticholinesterase activity.
Irinotecan: (Moderate) Concomitant use of succinylcholine and irinotecan may prolong neuromuscular blockade. Irinotecan has anticholinesterase activity.
Isoflurane: (Moderate) Additional monitoring or a dosage reduction may be required for some patients during concomitant use of succinylcholine and isoflurane. Concomitant use may prolong neuromuscular blockade and increase the risk for hyperkalemia and malignant hyperthermia. Anesthetic concentrations of isoflurane at equilibrium reduced the effective dose (ED95) of succinylcholine by approximately 25% to 40% or more compared to nitrous oxide/opioid anesthesia.
Isradipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Labetalol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Levamlodipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Levobunolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Lincosamides: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Lithium: (Moderate) Concomitant use of neuromuscular blockers and lithium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Loop diuretics: (Moderate) Concomitant use of neuromuscular blockers and loop diuretics may prolong neuromuscular blockade, possibly due to hypokalemia or alterations in potassium concentrations across the end-plate membrane.
Magnesium: (Moderate) Concomitant use of neuromuscular blockers and magnesium may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Methazolamide: (Moderate) Nondepolarizing neuromuscular blockers when combined with carbonic anhydrase inhibitors may lead to prolonged respiratory depression. This action is due to enhanced neural blockade as a result of potential hypokalemia from the carbonic anhydrase inhibitor. Serum potassium concentrations should be checked and adjusted prior to the administration of nondepolarizing neuromuscular blockers.
Metoclopramide: (Moderate) Consider reducing the dose of succinylcholine when metoclopramide is given concomitantly. Concomitant use of succinylcholine and metoclopramide may prolong neuromuscular blockade, possibly due to plasma cholinesterase inhibition by metoclopramide.
Metoprolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Minocycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Mivacurium: (Major) If succinylcholine is used before mivacurium, delay mivacurium administration until recovery from succinylcholine-induced neuromuscular blockade begins. Prior administration of succinylcholine may enhance the neuromuscular blocking effect of mivacurium.
Nadolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Nebivolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Nebivolol; Valsartan: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Neostigmine: (Moderate) Neostigmine does not antagonize, and may prolong, the Phase I block of succinylcholine. If given before succinylcholine is metabolized by cholinesterase, neostigmine may prolong rather than shorten paralysis. 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). When this diagnosis is confirmed with a peripheral nerve stimulator, it may sometimes be reversed with anticholinesterase drugs, such as neostigmine. Anticholinesterase drugs may not always be effective.
Neostigmine; Glycopyrrolate: (Moderate) Neostigmine does not antagonize, and may prolong, the Phase I block of succinylcholine. If given before succinylcholine is metabolized by cholinesterase, neostigmine may prolong rather than shorten paralysis. 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). When this diagnosis is confirmed with a peripheral nerve stimulator, it may sometimes be reversed with anticholinesterase drugs, such as neostigmine. Anticholinesterase drugs may not always be effective.
Nicardipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Nifedipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Nimodipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Nisoldipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Omadacycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Oral Contraceptives: (Moderate) Plasma cholinesterase activity may be diminished by chronic administration of oral contraceptives; consider the possibility of prolonged neuromuscular block after administration of succinylcholine in patients with reduced plasma cholinesterase activity. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Oxytocin: (Moderate) Concomitant use of succinylcholine and oxytocin may prolong neuromuscular blockade.
Pancuronium: (Major) If succinylcholine is used before pancuronium, delay pancuronium administration until recovery from succinylcholine-induced neuromuscular blockade begins. Prior administration of succinylcholine may enhance the neuromuscular blocking effect of pancuronium and increase its duration of action. If a small dose of pancuronium is given at least 3 minutes before administration of succinylcholine, in order to reduce the incidence and intensity of succinylcholine-induced fasciculations, this dose may induce a degree of neuromuscular block sufficient to cause respiratory depression in some patients.
Perindopril; Amlodipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Phenelzine: (Moderate) Plasma cholinesterase activity may be diminished by chronic administration of phenelzine; consider the possibility of prolonged neuromuscular block after administration of succinylcholine in patients with reduced plasma cholinesterase activity. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Phenytoin: (Moderate) Concomitant use of neuromuscular blockers and phenytoin may increase resistance to the neuromuscular blockade action of neuromuscular blockers, resulting in shorter durations of neuromuscular blockade and higher infusion rate requirements. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Physostigmine: (Contraindicated) Physostigmine is contraindicated in patients receiving succinylcholine due to reduced plasma cholinesterase activity and prolonged neuromuscular blockade.
Pindolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Polymyxin B: (Major) Avoid concomitant use of systemic polymyxin B and neuromuscular blockers due to the risk of respiratory depression. The neurotoxicity of polymyxin B may can result in neuromuscular blockade, especially when given soon after neuromuscular blockers. If signs of respiratory paralysis appear, assist respiration and discontinue drug therapy.
Procainamide: (Moderate) A lower neuromuscular blocker dose may be required to achieve neuromuscular block with concomitant procainamide use due to procainamide effects on reducing acetylcholine release. Concomitant use of neuromuscular blockers and procainamide may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Propranolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Pyridostigmine: (Moderate) Pyridostigmine does not antagonize, and may prolong, the Phase I block of succinylcholine. If given before succinylcholine is metabolized by cholinesterase, pyridostigmine may prolong rather than shorten paralysis. 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). When this diagnosis is confirmed with a peripheral nerve stimulator, it may sometimes be reversed with anticholinesterase drugs, such as pyridostigmine. Anticholinesterase drugs may not always be effective.
Pyridoxine, Vitamin B6: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade.
Quinidine: (Moderate) Concomitant use of neuromuscular blockers and quinidine may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Quinine: (Major) Avoid concomitant use of neuromuscular blockers and quinine. Quinine may enhance the action of neuromuscular blockers. In 1 patient who received a neuromuscular blocker during an operative procedure, subsequent administration of quinine 1,800 mg 3 hours later resulted in respiratory depression.
Rivastigmine: (Moderate) A synergistic effect may be expected when succinylcholine is given concomitantly with a cholinesterase inhibitor, such as rivastigmine.
Rocuronium: (Major) If succinylcholine is used before rocuronium, delay rocuronium administration until recovery from succinylcholine-induced neuromuscular blockade begins. The median duration of action of rocuronium 0.6 mg/kg administered after succinylcholine 1 mg/kg when T1 (defined as 3 twitches of train-of-four) returned to 75% of control was 36 minutes (range: 14 to 57, n = 12) vs. 28 minutes (range: 17 to 51, n = 12) without succinylcholine.
Sarecycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Sevoflurane: (Moderate) Additional monitoring or a dosage reduction may be required for some patients during concomitant use of succinylcholine and sevoflurane. Concomitant use may prolong neuromuscular blockade and increase the risk for hyperkalemia and malignant hyperthermia.
Sotalol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Stiripentol: (Moderate) Monitor for excessive sedation and somnolence during coadministration of stiripentol and succinylcholine. CNS depressants can potentiate the effects of stiripentol.
Telmisartan; Amlodipine: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Terbutaline: (Moderate) Concomitant use of succinylcholine and terbutaline may prolong neuromuscular blockade.
Tetracycline: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Tetracyclines: (Moderate) Concomitant use of neuromuscular blockers and tetracyclines may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Thalidomide: (Moderate) Use succinylcholine with caution in patients taking thalidomide due the risk of additive bradycardia.
Theophylline, Aminophylline: (Moderate) A higher neuromuscular blocker dose may be required to achieve neuromuscular block with concomitant aminophylline use. Aminophylline may antagonize neuromuscular blocking effects, possibly due to phosphodiesterase inhibition. (Moderate) A higher neuromuscular blocker dose may be required to achieve neuromuscular block with concomitant theophylline use. Theophylline may antagonize neuromuscular blocking effects, possibly due to phosphodiesterase inhibition.
Thiazide diuretics: (Moderate) Concomitant use of neuromuscular blockers and thiazide diuretics may prolong neuromuscular blockade, possibly due to hypokalemia or alterations in potassium concentrations across the end-plate membrane.
Thiotepa: (Moderate) Concomitant use of succinylcholine and thiotepa may prolong neuromuscular blockade. It has been theorized that this is caused by the anticholinesterase activity of anticancer drugs such as thiotepa.
Timolol: (Moderate) Concomitant use of neuromuscular blockers and beta-blockers may prolong neuromuscular blockade.
Trandolapril; Verapamil: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.
Vancomycin: (Moderate) Concomitant use of neuromuscular blockers and vancomycin may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Vecuronium: (Major) If succinylcholine is used before vecuronium, delay vecuronium administration until recovery from succinylcholine-induced neuromuscular blockade begins. With succinylcholine as the intubating agent, use initial vecuronium doses of 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05 to 0.06 mg/kg with balanced anesthesia. Prior administration of succinylcholine may enhance the neuromuscular blocking effect of vecuronium and its duration of action.
Verapamil: (Moderate) Concomitant use of neuromuscular blockers and calcium-channel blockers may prolong neuromuscular blockade.

Anectine/Quelicin/Succinylcholine/Succinylcholine Chloride Intramuscular Inj Sol: 1mL, 20mg
Anectine/Quelicin/Succinylcholine/Succinylcholine Chloride Intravenous Inj Sol: 1mL, 20mg

1.5 mg/kg/dose IV; 150 mg/dose IM.

1.5 mg/kg/dose IV; 150 mg/dose IM.

1.5 mg/kg/dose IV; 4 mg/kg/dose (Max: 150 mg/dose) IM.

2 to 12 years: 1.5 mg/kg/dose IV; 4 mg/kg/dose (Max: 150 mg/dose) IM.
1 year: 2 mg/kg/dose IV; 4 mg/kg/dose IM.

6 to 11 months: 2 mg/kg/dose IV; 4 mg/kg/dose IM.
1 to 5 months: 3 mg/kg/dose IV (Max: 4 mg/kg IV per intubation attempt); 5 mg/kg/dose IM.

3 mg/kg/dose IV (Max: 4 mg/kg IV per intubation attempt); 4 mg/kg/dose IM.

Muscle contraction is initiated by an action potential traveling from the central nervous system to the nerve terminal. At the nerve terminal, the action potential causes an influx of calcium, initiating release of acetylcholine (ACh) into the synaptic cleft. ACh binds to ACh receptors on the muscle fiber's motor end-plate causing a conformational change that briefly opens sodium ion channels. When an adequate number of ACh receptors are activated, membrane potential decreases and voltage-dependent sodium ion channels of adjacent muscle membranes activate, transmitting the action potential throughout the muscle fiber and resulting in muscle contraction.[52452] Succinylcholine, a depolarizing neuromuscular blocking agent, produces skeletal muscle paralysis by competing with ACh for cholinergic receptor sites at the motor end-plate. Like ACh, it activates the receptor and causes membrane depolarization. Because succinylcholine is resistant to degradation by acetylcholinesterase, it remains bound to the receptor and thereby inhibits repolarization, resulting in an extended duration of neuromuscular blockade. Depolarization results in fasciculation of the skeletal muscles and muscle paralysis. Neuromuscular transmission is inhibited until succinylcholine is degraded by pseudocholinesterase.[42039] [52452] [52486] The paralysis after succinylcholine administration is selective. Initially, paralysis involves the levator muscles of the face and muscles of the glottis. Paralysis consecutively involves the intercostals, the diaphragm, and all other skeletal muscles. Muscle tone generally returns in the reverse order. Succinylcholine has no direct effect on the uterus, myocardium, or other smooth muscle structures. Succinylcholine does, however, stimulate both autonomic ganglia and muscarinic receptors, which may affect cardiac rhythm.[42039]

Succinylcholine can be administered intravenously or intramuscularly. Succinylcholine is highly ionized and has low lipid solubility; it is rapidly distributed into the extracellular space. Succinylcholine is rapidly hydrolyzed by plasma cholinesterase to succinylmonocholine, a metabolite which possesses clinically insignificant depolarizing neuromuscular blocking properties. Succinylmonocholine is further hydrolyzed to succinic acid and choline. Up to 10% of a succinylcholine dose is excreted unchanged in the urine.[42039] [52452]
 
Plasma cholinesterase activity may be diminished in patients with genetic abnormalities of plasma cholinesterase, malignant tumors, infections, burns, anemia, decompensated heart disease, peptic ulcer, severe hepatic or renal dysfunction, or myxedema. In addition, chronic administration of drugs that antagonize plasma cholinesterase (e.g., oral contraceptives, glucocorticoids, monoamine oxidase inhibitors, cyclophosphamide) may decrease cholinesterase activity and increase duration of neuromuscular blockade.[42039] [52452]
 
Affected cytochrome P450 isoenzymes and drug transporters: none

After administration of succinylcholine 0.3 to 1.1 mg/kg IV in adults, neuromuscular blockade occurs in approximately 1 minute, maximum blockade may persist for about 2 minutes, after which recovery takes place within 4 to 6 minutes. Patients with low pseudocholinesterase concentrations may experience longer durations of action.[42039]

Onset of paralysis occurs in approximately 2 to 3 minutes after intramuscular administration. Patients with low pseudocholinesterase concentrations may experience longer durations of action.[42039]

There are no data on the presence of succinylcholine or its metabolite in human milk, the effects on the breast-fed infant, or the effects on milk production. However, the drug is rapidly eliminated and has poor oral absorption, so it is not likely to reach the circulation or cause adverse effects in breast-fed infants. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for succinylcholine and any potential adverse effects on the breast-fed child from succinylcholine or the underlying condition.