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Succinylcholine chloride Injection

[29 September 2014]

Products Affected - Description

Quelicin, Hospira
100 mg/mL, 10 mL vial (NDC 00409-6970-10) - discontinued
 
Anectine, Sandoz2
20 mg/mL, 10 mL vial (NDC 00781-3009-95)

Reason for the Shortage

  • Hospira had Quelicin on shortage due to manufacturing delays.1
  • Sandoz had Anectine on shortage due to extra quality reviews.2    

Available Products

Quelicin, Hospira1
20 mg/mL, 10 mL vial (NDC 00409-6629-02)

Estimated Resupply Dates

Sandoz has Anectine on intermittent back order and the company is releasing product regularly.2

Implications for Patient Care

Succinylcholine chloride injection is a depolarizing neuromuscular blocking agent and is typically a drug of choice for short procedures (3 minutes or less).3,4

Safety

  • Clinicians must use extreme caution if a different strength is used. Clinicians may elect to use an alternative agent rather than risk a 5-fold overdose or underdose.
  • Ensure supplies of succinylcholine are reserved for critical uses.

Alternative Agents & Management

  • During this shortage, clinicians should reserve supplies of succinylcholine for procedures where succinylcholine is the agent of choice.
  • Centers should make any operational changes necessary so that supplies of succinylcholine do not become outdated because of room temperature storage.
  • Alternative NMBAs vary in onset time and duration of action, particularly based on dose; see the table below. Times to re-dose also differ based on agent and dose. Doxacurium, mivacurium, and tubocurarine have been discontinued.3-5
  • Non-depolarizing neuromuscular blocking agents may be reversed with neostigmine or edrophonium. Depolarizing NMBAs (ie, succinylcholine) are not reversed by these agents and their toxicity may be worsened by concomitant administration.3-5

    Characteristics of NMBAs3-5

NMBA

Type of NMBA

Onset of Action (min)

Clinical Duration After Initial Dose (min)

Atracurium

Nondepolarizing

2 – 3 

20 – 35

Cisatracurium

Nondepolarizing

1.5 – 2

20 – 35

Pancuronium

Nondepolarizing

2 – 3 

60 – 100

Rocuronium

Nondepolarizing

1 – 2

22 – 67 min (depending on initial bolus dose)

Succinylcholine

Depolarizing

0.5 – 1

4 – 6

Vecuronium

Nondepolarizing

2.5 – 3

20 – 40

Related Shortages

References

  1. Hospira, Customer Service (personal communications and website). June 5, July 3, August 22, September 19, October 9, 15, 24, and 31, and November 13 and 19, 2012; January 8 and 16, March 6 and 15, April 1 and 10, May 13, June 24, July 15, August 6, September 12, November 4, December 2 and 16, 2013; January 30, March 20, April 16 and 28, May 12 and 23, June 23, July 29, and September 29, 2014.
  2. Sandoz, Customer Service (personal communications). June 6, July 3, August 22, September 19, November 14, 2012; January 8 and 16, March 6, April 4, May 13, June 24, July 25, August 6 and 8, September 12, November 1, December 4 and 16, 2013; January 30, March 20, April 16 and 28, May 14 and 27, June 23, July 28, and September 29, 2014. 
  3. Muscle Relaxants – Adjuncts to Anesthesia. In: Wickersham RM, Novack KK, eds. Drug Facts and Comparisons. Updated Monthly. St. Louis, MO: Facts and Comparisons; 2008:1047-1067.
  4. Neuromuscular Blocking Agents. In: McEvoy GK, Snow EK, Miller J, eds. AHFS 2008 Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1416-1433.
  5. Donnelly AJ, Baughman VL, Gonzales JP, Tomsik EA. Anesthesiology & Critical Care Drug Handbook. Hudson, OH: Lexi-Comp; 2005.

Updated

Updated September 29, 2014 by Megan Dryer, PharmD, Drug Information Specialist, Drug Information Service. Created April 11, 2002 by Jane Chandramouli, PharmD, Drug Information Specialist, and Erin R. Fox, PharmD, Director, Drug Information. Copyright 2014, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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