Skip to Content

Succinylcholine Injection

Last Updated: May 26, 2016
Status: Resolved

Products Affected - Description
    • Anectine injection, Sandoz, 20 mg/mL, 10 mL vial, 10 count, NDC 00781-3009-95
Reason for the Shortage
    • Hospira has a consistent supply of Quelicin injection.[1]
    • Sandoz discontinued Anectine in September 2015.[2]
Available Products
    • Quelicin injection, Pfizer, 20 mg/mL, 10 mL vial, 25 count, NDC 00409-6629-02

Estimated Resupply Dates

    • All marketed presentations are currently available.

Implications for Patient Care

    • Succinylcholine chloride injection is a depolarizing neuromuscular blocking agent and is typically a drug of choice for short procedures (3 minutes or less).[3,4]

Safety

    • Clinicians must use extreme caution if a different strength is used. Clinicians may elect to use an alternative agent rather than risk a 5-fold overdose or underdose.
    • Ensure supplies of succinylcholine are reserved for critical uses.

Alternative Agents & Management

    • During this shortage, clinicians should reserve supplies of succinylcholine for procedures where succinylcholine is the agent of choice.
    • Centers should make any operational changes necessary so that supplies of succinylcholine do not become outdated because of room temperature storage.
    • Alternative NMBAs vary in onset time and duration of action, particularly based on dose; see the table below. Times to re-dose also differ based on agent and dose. Doxacurium, mivacurium, and tubocurarine have been discontinued.[3,4,5]
    • Non-depolarizing neuromuscular blocking agents may be reversed with neostigmine or edrophonium. Depolarizing NMBAs (ie, succinylcholine) are not reversed by these agents and their toxicity may be worsened by concomitant administration.[3,4,5]
    Table 1. Characteristics of NMBAs3,4,5
    NMBA Type of NMBA Onset of Action (minutes) Clinical Duration After Initial Dose (minutes)
    Atracurium Nondepolarizing 2 to 3 20 to 35
    Cisatracurium Nondepolarizing 1.5 to 2 20 to 35
    Pancuronium Nondepolarizing 2 to 3 60 to 100
    Rocuronium Nondepolarizing 1 to 2 22 to 67 (depending on initial bolus dose)
    Succinylcholine Depolarizing 0.5 to 1 4 to 6
    Vecuronium Nondepolarizing 2.5 to 3 20 to 40

References

    1. Hospira, Customer Service (personal communications and website). June 5, July 3, August 22, September 19, October 9, 15, 24, and 31, and November 13 and 19, 2012; January 8 and 16, March 6 and 15, April 1 and 10, May 13, June 24, July 15, August 6, September 12, November 4, December 2 and 16, 2013; January 30, March 20, April 16 and 28, May 12 and 23, June 23, July 29, September 29, December 31, 2014; January 9, March 9, May 11, July 13 and 15, September 8 and November 11, 2015.
    2. Sandoz, Customer Service (personal communications). June 6, July 3, August 22, September 19, November 14, 2012; January 8 and 16, March 6, April 4, May 13, June 24, July 25, August 6 and 8, September 12, November 1, December 4 and 16, 2013; January 30, March 20, April 16 and 28, May 14 and 27, June 23, July 28, September 29, December 27, 2014; March 9, May 11, July 16, September 11 and November 11, 2015.
    3. Muscle Relaxants - Adjuncts to Anesthesia. In: Wickersham RM, Novack KK, eds. Drug Facts and Comparisons. Updated Monthly. St. Louis, MO: Facts and Comparisons; 2008:1047-1067.
    4. Neuromuscular Blocking Agents. In: McEvoy GK, Snow EK, Miller J, eds. AHFS 2008 Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1416-1433.
    5. Donnelly AJ, Baughman VL, Gonzales JP, Tomsik EA. Anesthesiology & Critical Care Drug Handbook. Hudson, OH: Lexi-Comp; 2005.

Updated

Updated May 26, 2016 by Leslie Jensen, PharmD, Drug Information Specialist. Created September 16, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2017, Drug Information Service, University of Utah, Salt Lake City, UT.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide