Suxamethonium chloride Panpharma

What Is Suxamethonium chloride Panpharma and What Is It Used For?

Suxamethonium chloride Panpharma contains suxamethonium chloride (internationally known as succinylcholine), a depolarizing neuromuscular blocking agent that produces rapid, short-duration skeletal muscle paralysis during general anesthesia in adults and children. It is the global gold standard for rapid sequence intubation (RSI) in emergency airway management.

Suxamethonium belongs to the class of depolarizing neuromuscular blocking agents. Chemically, its molecule consists of two acetylcholine molecules joined end-to-end, which explains why it can directly activate nicotinic acetylcholine receptors at the neuromuscular junction. When suxamethonium binds, it initially causes transient muscle contractions visible as fasciculations, followed by sustained depolarization of the motor end-plate and a characteristic flaccid paralysis. This mechanism clearly distinguishes suxamethonium from non-depolarizing agents such as rocuronium, vecuronium or cisatracurium, which competitively block the acetylcholine receptor without any initial stimulation.

The principal clinical indication for Suxamethonium chloride Panpharma is to facilitate endotracheal intubation during rapid sequence induction of anesthesia. Rapid sequence induction is a technique used when a patient requires emergency airway control and is considered at high risk of aspirating gastric contents into the lungs — for example in trauma, bowel obstruction, sepsis, pregnancy or any patient who has recently eaten. Suxamethonium is favored in this setting because it has the fastest onset of any neuromuscular blocker (30-60 seconds) and an ultra-short duration of action (2-6 minutes). If intubation fails, spontaneous breathing returns quickly, which is a critical safety feature in the "can't intubate, can't ventilate" scenario.

Beyond airway management, suxamethonium is also used for short surgical and medical procedures that require brief periods of muscle relaxation, such as reduction of dislocated joints, laryngoscopy, bronchoscopy and electroconvulsive therapy (ECT) in psychiatric practice. In emergency medicine it remains a cornerstone of airway management protocols worldwide and is recommended by organizations including the Difficult Airway Society (DAS), the American Society of Anesthesiologists (ASA), the European Society of Anaesthesiology and Intensive Care (ESAIC) and the World Health Organization, which lists suxamethonium on its Model List of Essential Medicines.

Suxamethonium is metabolized rapidly in the plasma by the enzyme plasma cholinesterase (also known as pseudocholinesterase or butyrylcholinesterase). This enzymatic hydrolysis is the reason for its ultra-short duration of action. However, roughly 1 in 2,500-3,200 people have an inherited variant of the enzyme with markedly reduced activity, and additional patients have acquired reductions due to liver disease, pregnancy, severe malnutrition or exposure to certain drugs. In these individuals, the effect of suxamethonium can be significantly prolonged, ranging from 20 minutes to several hours, requiring continued mechanical ventilation until spontaneous breathing recovers.

What Should You Know Before Receiving Suxamethonium chloride Panpharma?

Before receiving Suxamethonium chloride Panpharma, your anesthesiologist must be informed of your complete personal and family medical history, especially any history of malignant hyperthermia, muscle disease, unusual reactions to anesthesia, or sudden unexplained deaths during surgery. Several absolute contraindications exist, and many additional conditions require heightened precautions.

Contraindications

You must not receive Suxamethonium chloride Panpharma if any of the following applies to you:

• You are allergic (hypersensitive) to suxamethonium chloride or to any of the other ingredients listed in section "Contents"
• You have been told by a doctor that you have abnormal plasma cholinesterase activity (this enzyme breaks down the drug — if it does not function normally, paralysis can last for many hours)
• You, or anyone in your biological family, has ever experienced malignant hyperthermia (a rare inherited reaction to certain anesthetics, causing dangerously high body temperature and muscle rigidity, potentially fatal without immediate treatment)
• You have abnormally high blood potassium (hyperkalemia) already, or a medical condition that makes massive potassium release likely
• You or a family member has a muscle disorder such as myotonia congenita, paramyotonia congenita or dystrophia myotonica
• You have Duchenne muscular dystrophy, Becker muscular dystrophy or any other form of muscular dystrophy
• You have known acute phase rhabdomyolysis or a recent history of extensive muscle breakdown

Warnings and Precautions

Your anesthesiologist will exercise special caution if any of the following apply to you. Tell the medical team before your procedure if you:

• Have an infection associated with muscle stiffness (such as tetanus) or active tuberculosis
• Feel generally unwell, have a fever, or have an active cancer (especially with cachexia)
• Have anemia or significant malnutrition (both may reduce plasma cholinesterase activity)
• Have serious liver disease or severe kidney dysfunction
• Have an autoimmune disease or thyroid disorder (including myxedema)
• Have a connective tissue disease
• Have any heart condition (prior myocardial infarction, coronary artery disease, dysrhythmias, cardiomyopathy)
• Have recently undergone plasma exchange (plasmapheresis), which can transiently deplete plasma cholinesterase
• Have suffered a head injury, major trauma, or severe burns
• Have a spinal cord injury, nerve damage, stroke or muscle wasting
• Have a neuromuscular disease such as myasthenia gravis, Lambert-Eaton syndrome or amyotrophic lateral sclerosis
• Have recently injured your eye, have glaucoma or are undergoing intraocular surgery
• Have ever had an allergic reaction to a muscle relaxant or any other drug used during anesthesia
• Have been immobile for a prolonged period (increasing the risk of hyperkalemia)
• Have sepsis or are severely debilitated
• Are recovering from a stroke or have increased intracranial pressure

Suxamethonium produces a transient rise in intraocular pressure and should therefore be used with great caution in patients with open eye injuries or uncontrolled glaucoma. It also causes a small transient rise in intragastric pressure, usually offset by simultaneous increase in lower esophageal sphincter tone. The drug causes a predictable transient rise in serum potassium of approximately 0.5 mmol/L in healthy individuals, but this rise can be massive (up to 5-10 mmol/L) and life-threatening in patients with certain pathologies — particularly major burns more than 24-48 hours old, extensive trauma, paraplegia, denervation injuries, prolonged immobilization, and undiagnosed myopathies.

Allergic Reactions

Serious allergic reactions (anaphylaxis) can occur even if you have never previously received a neuromuscular blocking agent. Among neuromuscular blockers, suxamethonium is one of the most frequent causes of anesthesia-related anaphylaxis, with an incidence estimated at 1 in 1,500 to 1 in 10,000 administrations, varying by country and surveillance method. Symptoms typically include skin flushing or rash, urticaria, bronchospasm with wheezing and breathing difficulty, swelling of the face and airway, cardiovascular collapse, and loss of consciousness. At the first sign of an allergic reaction the anesthesiologist will stop administration and initiate emergency treatment with adrenaline (epinephrine), intravenous fluids and airway support. Cross-reactivity with other neuromuscular blocking drugs is possible, so careful allergy testing is recommended before any future anesthetic exposure.

Pregnancy and Breastfeeding

If you are pregnant, breastfeeding, think you may be pregnant or are planning a pregnancy, inform your doctor before receiving this medicine. Suxamethonium crosses the placenta in small amounts but is rapidly metabolized by both maternal and fetal plasma cholinesterase. It has been used historically and is still considered the agent of choice by many obstetric anesthesiologists for rapid sequence intubation during emergency cesarean section under general anesthesia. Pregnancy itself reduces plasma cholinesterase activity by approximately 25%, which may slightly prolong the duration of action. The decision to use suxamethonium during pregnancy rests with the anesthesiologist and is based on the individual clinical circumstances and available alternatives.

No specific data are available on the excretion of suxamethonium in human breast milk. However, due to its ultra-short duration, rapid metabolism and poor oral bioavailability (the molecule is quaternary and charged, so it does not cross gastrointestinal membranes), clinically relevant infant exposure is considered extremely unlikely. Breastfeeding can normally be resumed as soon as the mother has recovered from anesthesia and is alert enough to feed safely.

Use in Children and Adolescents

Extra caution and monitoring are required when Suxamethonium chloride Panpharma is administered to infants and children. Many anesthesiology societies now advise that routine use of suxamethonium in children should be avoided due to rare but catastrophic reports of cardiac arrest from hyperkalemia in children with undiagnosed skeletal muscle myopathies such as Duchenne muscular dystrophy. These myopathies may not yet be clinically apparent at the time of anesthesia, particularly in boys younger than 8 years.

In current practice, pediatric use of suxamethonium is typically reserved for emergency indications: management of laryngospasm unresponsive to other measures, emergency intubation when intravenous access is not available (in which case intramuscular administration may be used), and life-threatening situations where the speed of onset is essential. Children have higher volumes of distribution and require higher mg/kg doses than adults, particularly infants and neonates.

Use in the Elderly

Elderly patients may have reduced plasma cholinesterase activity, particularly if they have hepatic impairment, malnutrition or are taking medications that inhibit the enzyme. Clearance is slightly slower but this is rarely clinically significant at standard doses. Elderly patients are, however, more vulnerable to cardiac side effects such as bradycardia and arrhythmia, especially when suxamethonium is combined with digitalis-type drugs. Careful electrocardiographic monitoring is essential in this population.

How Does Suxamethonium chloride Panpharma Interact with Other Drugs?

Suxamethonium has numerous clinically important drug interactions. Some medicines inhibit plasma cholinesterase and prolong the paralysis; others enhance the neuromuscular block directly; a third group increases the risk of hyperkalemia or cardiac arrhythmias. Your anesthesiologist will review every current medication, supplement and recent exposure before administration.

Tell your doctor, nurse or anesthesia team about all medicines you are taking or have recently taken, including prescription drugs, over-the-counter products, herbal remedies and dietary supplements. The lists below cover the most clinically important interactions. Many of these relate either to inhibition of plasma cholinesterase (which prolongs the action of suxamethonium) or to additive effects at the neuromuscular junction or on the cardiovascular system.

Major Interactions

Other Important Interactions

You should also tell your anesthesiologist if you have recently received a blood transfusion, because transfused blood may transiently alter cholinesterase activity. Similarly, report any exposure to sheep dip or agricultural pesticides, because these often contain organophosphates that inhibit the enzyme irreversibly. If you use eye drops for glaucoma, particularly older preparations containing ecothiopate, inform the anesthesia team — these eye drops produce enough systemic absorption to cause clinically important prolongation of paralysis.

What Is the Correct Dosage of Suxamethonium chloride Panpharma?

The dose of Suxamethonium chloride Panpharma depends on body weight, the degree and duration of relaxation required, the route of administration, and the individual patient's response. The standard intravenous dose for adults is 1 mg/kg. The maximum total dose should not exceed 500 mg. This medicine is always administered by an anesthesiologist in a hospital setting.

Suxamethonium chloride Panpharma is administered as an intravenous (IV) injection or as a continuous intravenous infusion. Where IV access is not available, intramuscular administration is possible in emergency situations, particularly in children. The anesthesiologist will determine the appropriate dose based on weight, clinical situation, type of procedure and expected response. Ventilatory support and full monitoring must always be in place before administration.

Adults, Elderly and Adolescents Over 12 Years

Children and Infants

Infants and younger children are more resistant to the effects of suxamethonium per kilogram of body weight because they have a larger extracellular fluid volume. They therefore require higher mg/kg doses. Children and infants are also at increased risk of bradycardia, especially after the first or second dose, and atropine pre-medication (0.01-0.02 mg/kg IV) is often administered before suxamethonium in this age group.

Elderly Patients

The dose for elderly patients is the same as for younger adults: 1 mg/kg intravenously. However, elderly patients may have slower recovery if plasma cholinesterase activity is reduced by liver disease, malnutrition or medication. They are also more susceptible to cardiac arrhythmias, especially if they are taking digitalis-type medications such as digoxin. Continuous electrocardiographic monitoring and quantitative neuromuscular monitoring (train-of-four) are essential in this population, and an alternative agent may be preferred if significant cardiac risk factors are present.

Renal and Hepatic Impairment

No specific dose adjustment is required for patients with impaired kidney function, as the drug is metabolized in plasma and only inactive metabolites are excreted by the kidneys. However, in severe hepatic impairment, synthesis of plasma cholinesterase may be reduced, prolonging the duration of action. The anesthesiologist will administer the drug cautiously and monitor neuromuscular recovery with train-of-four stimulation.

Missed Dose

Because Suxamethonium chloride Panpharma is administered only in hospital by trained clinicians, missed doses in the conventional outpatient sense do not occur. If an additional dose is clinically required to maintain relaxation during a longer procedure, it will be administered by the anesthesiologist according to the ongoing neuromuscular monitoring.

Overdose

Because suxamethonium is administered in a hospital environment under tight medical supervision, overdose is uncommon. When it does occur, the principal manifestation is prolonged neuromuscular paralysis with respiratory depression or apnea. Management is supportive: maintaining a secure airway and mechanical ventilation until the drug is metabolized and spontaneous breathing returns. Sedation should be continued while the patient remains paralyzed to prevent awareness.

The use of anticholinesterase reversal agents such as neostigmine is generally avoided, because these drugs further inhibit plasma cholinesterase and will prolong the Phase I depolarizing block. If a Phase II (dual) block has developed — suggested by the appearance of fade on train-of-four stimulation or by post-tetanic potentiation — reversal with neostigmine combined with glycopyrrolate or atropine may be considered, guided by quantitative neuromuscular monitoring. Severe bradycardia responds to atropine; severe hyperkalemia is treated with calcium, insulin-dextrose and ion-exchange resins; malignant hyperthermia requires immediate dantrolene.

What Are the Side Effects of Suxamethonium chloride Panpharma?

Like all medicines, Suxamethonium chloride Panpharma can cause side effects, although not everyone experiences them. The most common side effects are post-operative muscle pain (myalgia), visible fasciculations and gastrointestinal discomfort. Rare but serious side effects include malignant hyperthermia, severe hyperkalemia, anaphylaxis, cardiac arrhythmias and prolonged paralysis.

Tell your doctor, nurse or hospital staff if you experience any side effects after your operation. This includes any effects not listed below. Serious allergic reactions (anaphylaxis) to suxamethonium are rare but can occur even in patients who have never previously received a neuromuscular blocking agent. Seek immediate medical attention if you notice signs of a severe allergic reaction such as difficulty breathing, wheezing, swelling of the face, lips, tongue or throat, skin rash, hives, itching or feeling faint.

Reporting Side Effects

If you experience any side effects, talk to your doctor, nurse or pharmacist. Suspected adverse drug reactions should also be reported directly via the national reporting scheme in your country (for example Yellow Card in the United Kingdom, FDA MedWatch in the United States, or the relevant national competent authority in the EU). Reporting these reactions helps regulators and clinicians monitor drug safety.

How Should Suxamethonium chloride Panpharma Be Stored?

Suxamethonium chloride Panpharma must be stored in a refrigerator at 2-8°C. It must not be frozen. The solution should be kept in the original packaging to protect from light and used immediately after opening. Do not use if the solution is discolored or contains visible particles.

Storage of this medicine is managed by hospital pharmacy and anesthesia departments. However, the following requirements apply:

• Temperature: Store in a refrigerator at 2°C to 8°C. Do not freeze.
• Light protection: Keep in the original packaging to protect from light, as suxamethonium solutions are light-sensitive.
• Single use: This medicine is intended for single immediate use. Any unused portion remaining in an opened ampoule must be discarded.
• Visual inspection: Always inspect before use. Do not use if the solution is discolored (should be clear and colorless) or contains visible particles or precipitate.
• Expiry date: Do not use after the expiry date printed on the ampoule and outer carton, next to "EXP" or "Expiry date". The expiry date refers to the last day of that month.
• Disposal: Unused or expired medicine should be disposed of in accordance with local hospital protocols and pharmaceutical waste regulations. Do not dispose of via wastewater or household waste.

The requirement for refrigeration is critical because suxamethonium progressively degrades at room temperature, losing potency over time. The degradation products include succinylmonocholine and choline, which have markedly reduced neuromuscular blocking activity. At 25°C, potency declines by roughly 5% per month; at 40°C degradation accelerates significantly. Hospital pharmacies maintain strict cold chain protocols (refrigerator temperature logs, alarm systems and emergency transfer procedures) to ensure the drug remains effective up to the labeled expiry date.

Short-term excursions outside the cold chain — for example during transfer between hospital departments or in emergency drug trays — are acceptable in line with the stability data supporting the product. Consult hospital pharmacy guidelines for the maximum permitted room-temperature exposure, which is typically 14 days but varies by product.

Keep this medicine out of the sight and reach of children. Because Suxamethonium chloride Panpharma is a hospital-only medicine, this requirement is met through secure storage cabinets in anesthesia, intensive care, emergency department and operating theatre environments.

What Does Suxamethonium chloride Panpharma Contain?

Each 1 ml of solution contains 50 mg of suxamethonium chloride as the active substance, together with hydrochloric acid or sodium hydroxide for pH adjustment and water for injections as excipients. A typical 2 ml ampoule therefore contains 100 mg of suxamethonium chloride.

Active Substance

The active substance is suxamethonium chloride at a concentration of 50 mg/ml. A standard 2 ml clear glass ampoule contains 100 mg of suxamethonium chloride. Suxamethonium (known internationally as succinylcholine) is a synthetic diester of succinic acid and choline, pharmacologically equivalent to two acetylcholine molecules joined tail-to-tail. This molecular structure explains its direct agonist activity at the nicotinic acetylcholine receptor of the neuromuscular junction and its rapid hydrolysis by plasma cholinesterase.

Other Ingredients (Excipients)

• Hydrochloric acid and/or sodium hydroxide — used to adjust the pH of the solution to the acidic range (approximately pH 3.0-5.0) required for stability of the active molecule
• Water for injections — the solvent base meeting European Pharmacopoeia standards

The product does not contain preservatives, sulfites, sodium benzoate or latex. It is suitable for patients with known preservative sensitivities. Patients concerned about specific excipients should consult the full Summary of Product Characteristics (SmPC) available from the national medicines agency.

Appearance and Packaging

Suxamethonium chloride Panpharma solution for injection/infusion is a clear, colorless solution supplied in clear glass ampoules (type I glass). Each 2 ml ampoule contains 100 mg of suxamethonium chloride. The product is packaged in cartons of 10 ampoules (10 × 2 ml). Not all pack sizes may be marketed in every country.

Marketing Authorization Holder and Manufacturer

Panpharma, Z.I. du Clairay, 35133 Luitré, France. Panpharma is a French pharmaceutical manufacturer specializing in injectable medicines for hospital use, particularly antibiotics, analgesics and anesthetic agents. The company operates under European GMP standards and distributes products across Europe, the Middle East, Africa and Asia.

This medicine is authorized in several European Economic Area countries under various trade names, including Suxamethonium Panpharma, Suxamethonium chloride Panpharma, Succinylcholine Panpharma and Suxaméthonium Panpharma, depending on national naming conventions.

Dilution Instructions (For Healthcare Professionals)

For continuous intravenous infusion, suxamethonium may be diluted to a 0.1% to 0.2% solution (1-2 mg/ml) using 5% glucose solution (50 mg/ml glucose) or sterile 0.9% sodium chloride (isotonic saline). Diluted solutions should be used immediately and should not be stored. The infusion rate is typically 2.5 to 4 mg per minute, adjusted according to the patient's clinical response and quantitative neuromuscular monitoring. The product is for single use only; any unused solution should be discarded in accordance with hospital protocols.