DIRA 1.0: Atlas of Drug-induced Rhabdomyolysis

SUCCINYLCHOLINE CHLORIDE

DIR Classification Postmarketing Surveillance Drug Property Information Reference

DIR Classification

Classification:Most-DIR concern

Severity Score:4

Description in Drug Labeling: View Full Labeling: SPL in DailyMed | PDF

BOXED WARNING
RISK OF CARDIAC ARREST FROM HYPERKALEMIC RHABDOMYOLYSIS
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 children 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 children (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents.
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 children 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).

Postmarketing Surveillance

Contingency Table:

Current Drug

Other Drugs

Rhabdomyolysis

42887

Other ADRs

598

14116681

Odds Ratio = 13.761

Drug Property Information

ATC Code(s):

M03AB01 - succinylcholine chloride

M03AB - Choline derivatives
M03A - "MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS"
M03 - MUSCLE RELAXANTS
M - MUSCULO-SKELETAL SYSTEM

Active Ingredient:succinylcholine chloride

Active Ingredient UNII:I9L0DDD30I

Drugbank ID:DB00202

PubChem Compound:5314

CAS Number:306-40-1

Dosage Form(s):injection, solution

Route(s) Of Administrator:intramuscular; intravenous; parenteral

Daily Dose:

Chemical Structure:

SMILE Code:
C[N+](C)(C)CCOC(=O)CCC(=O)OCC[N+](C)(C)C

Reference

COHORT STUDY:

N/A

OTHER REFERENCE(S):

1: [Rhabdomyolysis induced by succinylcholine chloride and sevoflurane in an elderly man].

[Takamatsu F,Taoda M,Uchihashi Y,Satoh T]
Masui.1996 Nov;45(11):1406-9. PMID: 8953878

2: [Rhabdomyolysis with myoglobinuric acute renal failure following the use of succinylcholine chloride and enflurane in a mentally-retarded patient: a case report].

[Lee S C,Furutani M,Yoshitake K,Sato T,Lin Y S,Shong K L,Wang M H]
Ma Zui Xue Za Zhi.1987 Jun;25(2):97-102. PMID: 3669958

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