suxamethonium chloride

CLINICAL USE

Depolarising muscle relaxant used in short procedures and ECT

DOSE IN NORMAL RENAL FUNCTION

IV injection: 0.5–1 mg/kg

IV infusion

: 2.5–4 mg/minute; maximum 500 mg/hour

PHARMACOKINETICS

Molecular weight :397.3

%Protein binding :70

%Excreted unchanged in urine :

<10 :

Volume of distribution (L/kg) :No data

half-life – normal/ESRD (hrs) :2–3 minutes/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function. Use with caution.

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: increased risk of myocardial depression and bradycardia with propofol; enhanced effect with volatile liquid general anaesthetics

Anti-arrhythmics: lidocaine and procainamide enhance muscle relaxant effect

Antibacterials: effect enhanced by aminoglycosides, clindamycin, polymyxins, vancomycin and piperacillinCardiac glycosides: increased risk of cardiac arrhythmias with digoxin

ADMINISTRATION

Reconstition

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Route

Rate of Administration

Over 10–30 seconds Infusion: 2.5–4 mg/minute, maximum 500 mg/hour

Comments

For continuous infusion add 10 mL to 500 mL glucose 5% or sodium chloride 0.9% = 0.1% solution

OTHER INFORMATION

Suxamethonium is predominantly excreted in the urine as active and inactive metabolites. Patients on dialysis may require a dose at the lower end of the range due to reduced plasma cholinesterase activityUse with caution in hyperkalaemia as potassium is released from depolarised muscleHyperkalaemia may occur when suxamethonium is used in CKD 5

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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