QUELICIN PRESERVATIVE FREE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for QUELICIN PRESERVATIVE FREE (QUELICIN PRESERVATIVE FREE).
Depolarizing neuromuscular blocker that binds to nicotinic acetylcholine receptors at the motor end-plate, causing initial depolarization followed by sustained membrane depolarization and neuromuscular blockade.
| Metabolism | Rapidly hydrolyzed by plasma butyrylcholinesterase (pseudocholinesterase) to succinylmonocholine and choline; further metabolized to succinic acid and choline. |
| Excretion | Primarily hydrolyzed by plasma pseudocholinesterase; less than 2% excreted unchanged in urine; minimal biliary/fecal elimination. |
| Half-life | 2 to 4 minutes (pseudocholinesterase-mediated hydrolysis); prolonged in patients with atypical pseudocholinesterase or hepatic impairment. |
| Protein binding | Approximately 30–50% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | 0.3–0.6 L/kg; distributes rapidly into extracellular fluid, minimal CNS penetration. |
| Bioavailability | 100% IV; IM absorption variable (not used therapeutically for anesthesia induction due to unreliable absorption). |
| Onset of Action | Intravenous: 30–60 seconds; Intramuscular: 2–4 minutes (primarily used IV). |
| Duration of Action | IV: 4–6 minutes for single dose (clinical apnea); longer with repeated doses or continuous infusion (risk of phase II block). |
1.0-2.0 mg/kg intravenously; 0.3-1.1 mg/kg intramuscularly. For intravenous administration, typical adult dose is 40-100 mg. Repeat doses of 0.04-0.07 mg/kg as needed for maintenance.
| Dosage form | INJECTABLE |
| Renal impairment | No adjustment required for mild to moderate renal impairment. In severe renal impairment (GFR < 10 mL/min), use with caution due to potential hyperkalemia. Dose reduction not typically needed. |
| Liver impairment | No dose adjustment required for mild to moderate hepatic impairment (Child-Pugh A or B). For severe hepatic impairment (Child-Pugh C), use with caution; consider dose reduction due to prolonged duration of action, but specific dosing guidelines not established. |
| Pediatric use | Intravenous: 1.0-2.0 mg/kg intubating dose. Maintenance: 0.03-0.06 mg/kg as needed. Intramuscular: 2.0-2.5 mg/kg (up to 150 mg total). |
| Geriatric use | Use lower end of dosing range (e.g., 0.6-1.0 mg/kg IV) due to prolonged duration of action and increased risk of hyperkalemia. Monitor serum potassium and cardiac function closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for QUELICIN PRESERVATIVE FREE (QUELICIN PRESERVATIVE FREE).
| Breastfeeding | Excretion into breast milk is unknown; likely minimal due to rapid hydrolysis and short half-life. M/P ratio not available. Use with caution; consider delaying breastfeeding until drug effect subsides (approx. 10-20 min after dose). |
| Teratogenic Risk | Succinylcholine (QUELICIN) is a depolarizing neuromuscular blocker. Limited human data; animal studies show no teratogenicity at clinically relevant doses. Risk cannot be excluded. Avoid in first trimester unless essential. Third trimester: increased risk of maternal respiratory depression, but no known specific fetal malformations. |
■ FDA Black Box Warning
Risk of cardiac arrest from hyperkalemia in susceptible patients such as those with burns, trauma, severe acidosis, neuromuscular disease, or prolonged immobility. Use only when skilled personnel and resuscitative equipment are immediately available.
| Common Effects | Dizziness Dryness in mouth Sleepiness Constipation Fatigue High blood pressure Orthostatic hypotension sudden lowering of blood pressure on standing Dyslipidemia |
| Serious Effects |
Absolute: Known hypersensitivity to succinylcholine; susceptibility to malignant hyperthermia; history of hyperkalemia-related cardiac arrest with succinylcholine; genetic deficiency of plasma butyrylcholinesterase (pseudocholinesterase). Relative: Severe burns, trauma, spinal cord injury, neuromuscular diseases (e.g., Duchenne muscular dystrophy), stroke, multiple sclerosis, prolonged immobilization, acidosis, hyperkalemia, elevated intraocular pressure (e.g., glaucoma), open eye injury, major electrolyte imbalances.
| Precautions | Risk of hyperkalemia, malignant hyperthermia, bradycardia, increased intraocular/intragastric pressure, prolonged block in patients with genetic variants of butyrylcholinesterase, and anaphylaxis. |
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| Fetal Monitoring | Monitor maternal vital signs, oxygen saturation, and neuromuscular function (train-of-four). Fetal heart rate monitoring during prolonged use. Watch for malignant hyperthermia and prolonged apnea (especially in pseudocholinesterase deficiency). |
| Fertility Effects | No known adverse effects on human fertility. Animal studies not suggestive of reproductive toxicity. |