Chemical formula: C₁₄H₃₀N₂O₄+₂ Molecular mass: 290.399 g/mol PubChem compound: 5314
Suxamethonium interacts in the following cases:
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Parenteral magnesium – enhanced neuromuscular blockade.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with:
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
These include:
The following have potentially adverse effects on plasma cholinesterase activity:
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Azathioprine – prolonged neuromuscular blockade.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Bambuterol and terbutaline – enhanced effects of suxamethonium.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with:
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Diphenhydramine – enhanced effects of suxamethonium.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with:
Halothane, enflurane, desflurane, isoflurane, diethylether and methoxyflurane have little effect on the Phase I block of suxamethonium but will accelerate the onset and enhance the intensity of a Phase II suxamethonium-induced block.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with metoclopramide.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with morphine, morphine antagonists, pethidine, pancuronium.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with:
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Enhanced effects of suxamethonium with:
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of suxamethonium.
Quinine-effects of suxamethonium possibly enhanced.
Suxamethonium causes a transient increase in intraocular pressure and should not be used in the presence of penetrating eye injury except where the potential benefits outweigh the injury to the eye.
Suxamethonium should be used with caution in patients with fractures or muscle spasms because the initial muscle fasciculations may cause additional trauma.
Suxamethonium should be used with caution in ill and cachectic patients, in patients with acid-base disturbances or electrolyte imbalance, parenchymatous liver disease, obstructive jaundice, carcinomatosis, in those in contact with certain insecticides, e.g. organophosphorous compounds and in those receiving therapeutic radiation.
In healthy adults, suxamethonium occasionally causes a mild transient slowing of the heart rate on initial administration.
Bradycardias are more commonly observed in children and on repeated administration of suxamethonium in both children and adults. Pre-treatment with intravenous atropine or glycopyrrolate significantly reduces the incidence and severity of suxamethonium-related bradycardia.
In the absence of pre-existing or evoked hyperkalaemia, ventricular arrhythmias are rarely seen following suxamethonium administration. Cardiac arrhythmias can develop in patients receiving digitalis glycosides who are given suxamethonium. Patients taking digitalis-like drugs are however more susceptible to such arrhythmias. The action of suxamethonium on the heart may cause changes in cardiac rhythm including cardiac arrest.
Suxamethonium has no direct action on the uterus or other smooth muscle structures. In normal therapeutic doses it does not cross the placental barrier in sufficient amounts to affect the respiration of the infant.
The benefits of the use of suxamethonium as part of a rapid sequence induction for general anaesthesia normally outweigh the possible risk to the foetus.
Plasma cholinesterase levels fall during the first trimester of pregnancy to about 70 to 80% of their pre-pregnancy values; a further fall to about 60 to 70% of the pre-pregnancy levels occurs within 2 to 4 days after delivery. Plasma cholinesterase levels then increase to reach normal over the next 6 weeks. Consequently, a high proportion of pregnant and puerperal patients may exhibit mildly prolonged neuromuscular blockade following suxamethonium injection.
Suxamethonium chloride should not be used unless clearly necessary.
It is not known whether suxamethonium is excreted in breast milk, therefore, caution should be exercised following administration of suxamethonium to nursing mothers.
No studies of the effect of suxamethonium on female fertility or pregnancy have been performed.
Suxamethonium chloride has a major influence on the ability of an individual to drive or operate machinery.
This precaution is not relevant to the use of suxamethonium. Suxamethonium will always be used in combination with a general anaesthetic and therefore the usual precautions relating to performance of tasks following general anaesthesia apply.
There is limited clinical documentation that can be used as support for determining the frequency of adverse reactions. The frequency categories assigned to the adverse reactions are estimates. For most reactions, the frequency was determined from published data and the background incidence was not considered when determining the frequency groups.
Adverse reactions are listed below by system organ class and frequency. Estimated frequencies were determined from published data.
Frequencies are defined as follows: very common (≥1/10); common (≥1/100 and <1/10); uncommon (≥1/1,000 and <1/100); rare (≥1/10,000 and <1/1,000); very rare (<1/10,000).
Very Rare: Anaphylactic reactions
Common: Increased intraocular pressure
Common: Bradycardia, tachycardia
Rare: Arrhythmias (including ventricular arrhythmias), cardiac arrest1
Common: Skin flushing. Hypertension and hypotension have also been reported.
Rare: Bronchospasm, prolonged respiratory depression2, apnoea.
Very Common: Increased intragastric pressure. Excessive salivation has also been reported
Common: Rash
Very common: Muscle fasciculation, post-operative muscle pains
Common: Myoglobinaemia3, myoglobinuria3
Rare: Trismus
Vary rare: Malignant hyperthermia
Common: Transient blood potassium increase
1 There are case reports of hyperkalaemia-related cardiac arrests following the administration of suxamethonium to patients with congenital cerebral palsy, tetanus, Duchenne muscular dystrophy, and closed head injury. Such events have also been reported rarely in children with hitherto undiagnosed muscular disorders.
2 Individuals with decreased plasma cholinesterase activity exhibit a prolonged response to suxamethonium. Approximately 0.05% of the population has an inherited cause of reduced cholinesterase activity.
3 Rhabdomyolysis has also been reported.
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