Succinylcholine

ANECTINE is indicated in adults and pediatric patients: • as an adjunct to general anesthesia • to facilitate tracheal intubation • to provide skeletal muscle relaxation during surgery or mechanical ventilation. ANECTINE is a depolarizing neuromuscular blocker indicated in adults and pediatric patients: • as an adjunct to general anesthesia. • to facilitate tracheal intubation. • to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Succinylcholine is a depolarizing neuromuscular blocker. As does acetylcholine, it combines with the cholinergic receptors of the motor end plate to produce depolarization. This depolarization may be observed as fasciculations. Subsequent neuromuscular transmission is inhibited so long as adequate concentration of succinylcholine remains at the receptor site. Onset of flaccid paralysis is rapid (less than one minute after intravenous administration), and with single administration lasts approximately 4 to 6 minutes. The paralysis following administration of succinylcholine is progressive, with differing sensitivities of different muscles. This initially involves consecutively the levator muscles of the face, muscles of the glottis, and finally, the intercostals and the diaphragm and all other skeletal muscles.

• For intravenous or intramuscular use only. • Individualize dosage after careful assessment of the patient. • Accidental administration of neuromuscular blocking agents may be fatal. Store ANECTINE with the cap and ferrule intact and in a manner that minimizes the possibility of selecting the wrong product. • See full prescribing information for ANECTINE dosage recommendations, preparation instructions, and administration information.

ANECTINE is contraindicated in patients with: • Known or suspected genetic susceptibility to malignant hyperthermia • Skeletal muscle myopathies • Known hypersensitivity to succinylcholine • After the acute phase of injury following major burns, multiple trauma, extensive denervation of the skeletal muscle, or upper neuron injury because succinylcholine administered to such individuals may result in severe hyperkalemia, which may result in cardiac arrest • Skeletal muscle myopathies. • Known hypersensitivity to succinylcholine. • After the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury.

Boxed warning: Acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death has occurred after the administration of succinylcholine to apparently healthy pediatric patients who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy. • Anaphylaxis: Severe anaphylactic reactions to neuromuscular blocking agents, including succinylcholine, have been reported. Some cases have been life-threatening and fatal. Take necessary precautions, such as the immediate availability of appropriate emergency treatment. • Risk of Death due to Medication Errors: Unintended administration of ANECTINE results in paralysis, which may lead to respiratory arrest and death.

The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling: • Ventricular Dysrhythmias, Cardiac Arrest and Death from Hyperkalemic Rhabdomyolysis in Pediatric Patients • Anaphylaxis • Hyperkalemia • Malignant hyperthermia • Bradycardia • Increased intraocular pressure • Prolonged Neuromuscular Block due to Phase II Block and Tachyphylaxis The following adverse reactions associated with the use of succinylcholine were identified in clinical studies or postmarketing reports.

Drugs that may Enhance the Neuromuscular Blocking Action of Succinylcholine: promazine, oxytocin, aprotinin, certain non-penicillin antibiotics, quinidine, β-adrenergic blockers, procainamide, lidocaine, trimethaphan, lithium carbonate, magnesium salts, quinine, chloroquine, isoflurane, desflurane, metoclopramide, terbutaline, and drugs that reduce plasma cholinesterase activity.

Store in refrigerator at 2° to 8°C (36° to 46°F). The multi-dose vials are stable for up to 14 days at room temperature without significant loss of potency.