Suxonium

Administer intravenously (IV) as a bolus injection or continuous infusion by trained medical personnel. Intramuscular (IM) administration is possible in emergencies but requires higher doses and has a slower onset.

Suxamethonium acts as an acetylcholine receptor agonist at the neuromuscular junction. It binds to nicotinic acetylcholine receptors, causing persistent depolarization of the motor end-plate. This initial depolarization leads to transient muscle fasciculations, followed by sustained paralysis as the muscle membrane becomes unresponsive to further acetylcholine release.

• Known hypersensitivity to suxamethonium.
• History of malignant hyperthermia or genetic susceptibility.
• Conditions predisposing to hyperkalemia (e.g., severe burns, crush injuries, major trauma, spinal cord injury, neuromuscular diseases like Duchenne muscular dystrophy, paraplegia/quadriplegia) for 24-48 hours after injury.
• Patients with low plasma pseudocholinesterase activity.
• Penetrating eye injuries or conditions where increased intraocular pressure is detrimental.
• Neuromuscular disorders (e.g., myasthenia gravis, Eaton-Lambert syndrome).
• Acute narrow-angle glaucoma.

Store in a refrigerator (2°C to 8°C). Do not freeze. Protect from light. Once reconstituted, use immediately.

Overdose results in prolonged skeletal muscle paralysis and respiratory depression/apnea. Management involves maintaining a patent airway and providing controlled mechanical ventilation until spontaneous respiration returns. Monitoring of vital signs and neuromuscular function is essential.

Pregnancy Category C. Use only if potential benefit outweighs potential risk to the fetus. It does not readily cross the placental barrier. Lactation: Limited data, but due to its rapid hydrolysis, significant excretion into breast milk is unlikely. Caution advised.