QUELICIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for QUELICIN (QUELICIN).
Depolarizing neuromuscular blocker that binds to nicotinic acetylcholine receptors at the motor end-plate, causing persistent depolarization and preventing repolarization, resulting in neuromuscular blockade.
| Metabolism | Hydrolyzed by plasma pseudocholinesterase (butyrylcholinesterase) to succinylmonocholine and then to succinic acid and choline. |
| Excretion | Primarily hydrolyzed by plasma pseudocholinesterase; less than 2% excreted unchanged in urine; minimal biliary/fecal elimination. |
| Half-life | Terminal elimination half-life is approximately 2-4 minutes in normal patients; prolonged to 20-40 minutes in patients with pseudocholinesterase deficiency. |
| Protein binding | Approximately 90% bound, primarily to albumin. |
| Volume of Distribution | 0.3-0.6 L/kg; distributes into extracellular fluid and is rapidly equilibrated with the neuromuscular junction. |
| Bioavailability | Intravenous: 100%; Intramuscular: 80-100% but not routinely used due to unreliable absorption and irritation. |
| Onset of Action | Intravenous (IV): 30-60 seconds; Intramuscular (IM): 2-3 minutes. |
| Duration of Action | IV: 2-4 minutes (due to rapid hydrolysis); prolonged in pseudocholinesterase deficiency or atypical variants. |
1 mg/kg IV bolus for rapid sequence intubation; maintenance infusion 0.5-1 mg/min IV for prolonged procedures.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required based on GFR; however, prolonged effect may occur in patients with renal impairment due to reduced pseudocholinesterase activity. |
| Liver impairment | No specific Child-Pugh-based adjustment; severe hepatic impairment may reduce pseudocholinesterase levels, prolonging effect; use with caution. |
| Pediatric use | 1-2 mg/kg IV for rapid sequence intubation; maintenance infusion 0.5-1 mg/min titrated to effect. |
| Geriatric use | Consider reduced initial dose (0.5-0.75 mg/kg IV) due to age-related decline in pseudocholinesterase activity; monitor for prolonged paralysis. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for QUELICIN (QUELICIN).
| Breastfeeding | Succinylcholine is excreted into breast milk in negligible amounts due to its short half-life and rapid hydrolysis. The M/P ratio is not established. It is considered compatible with breastfeeding based on lack of reported adverse effects in nursing infants. However, caution should be exercised due to potential for neuromuscular blockade if infant is exposed. |
| Teratogenic Risk | Succinylcholine (QUELICIN) is classified as FDA Pregnancy Category C. Animal studies have shown adverse effects on fetal development at high doses, but no adequate well-controlled studies in pregnant women. It crosses the placenta minimally. Use only if clearly needed, especially during first trimester. Fetal risks are low when used appropriately for cesarean section. |
■ FDA Black Box Warning
Risk of cardiac arrest from hyperkalemia in children and adolescents with undiagnosed skeletal muscle myopathies, particularly Duchenne muscular dystrophy. Use caution in patients with fractures or dislocations due to risk of additional injury from muscle fasciculations. Risk of malignant hyperthermia. Do not use in patients with known susceptibility.
| Common Effects | Dizziness Dryness in mouth Sleepiness Constipation Fatigue High blood pressure Orthostatic hypotension sudden lowering of blood pressure on standing Dyslipidemia |
| Serious Effects |
["Known hypersensitivity to succinylcholine","Patients with personal or family history of malignant hyperthermia","Patients with skeletal muscle myopathies (e.g., Duchenne muscular dystrophy) in children and adolescents","Patients with genetically determined plasma pseudocholinesterase deficiency","Patients with narrow-angle glaucoma","Patients with penetrating eye injuries (risk of vitreous loss)"]
| Precautions | ["Cardiac arrest from hyperkalemia in children and adolescents with undiagnosed myopathies","Malignant hyperthermia","Increased intraocular and intragastric pressure","Risk of prolonged paralysis in patients with pseudocholinesterase deficiency","Avoid in patients with fractures or dislocations due to muscle fasciculations","Use with caution in patients with electrolyte imbalances or digitalis toxicity as may precipitate arrhythmias"] |
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| Fetal Monitoring | Monitor maternal vital signs, oxygen saturation, and ECG. Use peripheral nerve stimulator to assess degree of neuromuscular blockade. Fetal heart rate monitoring is recommended during cesarean section. Be prepared for prolonged apnea in patients with pseudocholinesterase deficiency. |
| Fertility Effects | No known direct effects on fertility from succinylcholine. No human studies evaluating impact on fertility. Animal reproduction studies have not been conducted to assess fertility impairment. |