View source for Suxamethonium chloride

{{Short description|Chemical compound}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{infobox drug
| Verifiedfields = changed
| verifiedrevid = 477162668
| image = Suxamethonium-chloride-2D-skeletal.svg
| image_class = skin-invert-image
| alt = 
| image2 = Suxamethonium chloride ball-and-stick.png
| image_class2 = bg-transparent
| alt2 =

<!--Clinical data-->
| pronounce = {{IPAc-en|ˌ|s|ʌ|k|s|ᵻ|n|ᵻ|l|ˈ|k|oʊ|l|iː|n}}
| tradename = Quelicin, Anectine, others
| Drugs.com = {{drugs.com|monograph|succinylcholine-chloride}}
| DailyMedID = Succinylcholine
| pregnancy_AU = A
| routes_of_administration = [[Intravenous therapy|Intravenous]], [[intramuscular]]
| ATC_prefix = M03
| ATC_suffix = AB01
| ATC_supplemental =

| legal_AU = S4
| legal_CA          = Rx-only
| legal_CA_comment  = <ref>{{cite web | title=Product monograph brand safety updates | website=Health Canada | date=February 2024 | url=https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database/label-safety-assessment-update/product-monograph-brand-safety-updates.html | access-date=24 March 2024}}</ref>
| legal_UK = POM
| legal_US = Rx-only
| legal_US_comment = <ref name="Anectine FDA label">{{cite web | title=Anectine- succinylcholine chloride injection, solution | work = DailyMed | publisher = U.S. National Library of Medicine | date=17 September 2018 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a1e5d29f-111e-4a44-addf-beeb6ea81711 | access-date=23 November 2020}}</ref><ref name="Quelicin FDA label" />

<!--Pharmacokinetic data-->
| bioavailability = NA
| protein_bound =
| metabolism = {{nowrap|By [[Butyrylcholinesterase|pseudocholinesterase]],}} to [[succinylmonocholine]] and [[choline]]
| onset = 30–60 sec (IV), 2–3 min (IM) 
| elimination_half-life = 
| duration_of_action = < 10 min (IV), 10–30 min (IM)
| excretion = [[Kidney]] (10%)

<!--Identifiers-->
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 306-40-1
| PubChem = 22475
| IUPHAR_ligand = 4004
| DrugBank_Ref = {{drugbankcite|changed|drugbank}}
| DrugBank = DB00202
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 21080
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = J2R869A8YF
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00766
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 61219
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 983

<!--Chemical data-->
| IUPAC_name = 2,2'-[(1,4-dioxobutane-1,4-diyl)bis(oxy)]bis<br />(''N'',''N'',''N''-trimethylethanaminium)
| C=14 | H=30 | Cl=2 | N=2 | O=4
| smiles = [Cl-].[Cl-].O=C(OCC[N+](C)(C)C)CCC(=O)OCC[N+](C)(C)C
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C14H30N2O4.2ClH/c1-15(2,3)9-11-19-13(17)7-8-14(18)20-12-10-16(4,5)6;;/h7-12H2,1-6H3;2*1H/q+2;;/p-2
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = YOEWQQVKRJEPAE-UHFFFAOYSA-L
}}

<!-- Definition and medical uses -->
'''Suxamethonium chloride''' (brand names '''Scoline''' and '''Sucostrin''', among others), also known as '''suxamethonium''' or '''succinylcholine''', or simply '''sux''' in medical abbreviation,<ref name="Lee2009">{{cite journal |vauthors=Lee C, Katz RL |date=March 2009 |title=Clinical implications of new neuromuscular concepts and agents: so long, neostigmine! So long, sux! |journal=Journal of Critical Care |volume=24 |issue=1 |pages=43–49 |doi=10.1016/j.jcrc.2008.08.009 |pmid=19272538}}</ref> is a medication used to cause short-term [[paralysis]] as part of [[general anesthesia]].<ref name=WHO2008/> This is done to help with [[tracheal intubation]] or [[electroconvulsive therapy]].<ref name=WHO2008>{{cite book | title = WHO Model Formulary 2008 | year = 2009 | isbn = 9789241547659 | vauthors = ((World Health Organization)) | veditors = Stuart MC, Kouimtzi M, Hill SR | hdl = 10665/44053 | author-link = World Health Organization | publisher = World Health Organization |pages=426–8 | hdl-access=free }}</ref> It is administered by injection, either [[intravenous|into a vein]] or [[intramuscular|into a muscle]].<ref name=AHFS2016/> When used in a vein, onset of action is generally within one minute and effects last for up to 10 minutes.<ref name=AHFS2016/>

<!-- Side effects and mechanism -->
Common side effects include [[low blood pressure]], increased [[saliva]] production, [[muscle pain]], and rash.<ref name=AHFS2016>{{cite web|title=Succinylcholine Chloride|url=https://www.drugs.com/monograph/succinylcholine-chloride.html|publisher=The American Society of Health-System Pharmacists|access-date=8 December 2016|url-status=live|archive-url=https://web.archive.org/web/20161221012533/https://www.drugs.com/monograph/succinylcholine-chloride.html|archive-date=21 December 2016}}</ref> Serious side effects include [[malignant hyperthermia]], [[hyperkalemia]] and [[allergic reactions]].<ref>{{cite web|title=Anectine Injection - Summary of Product Characteristics (SPC) - (eMC)|url=https://www.medicines.org.uk/emc/medicine/704|website=www.medicines.org.uk|access-date=16 December 2016|date=12 January 2016|url-status=live|archive-url=https://web.archive.org/web/20161220191653/https://www.medicines.org.uk/emc/medicine/704|archive-date=20 December 2016}}</ref><ref name="FDA PR 20201222">{{cite press release |title=Coronavirus (COVID-19) Update: December 22, 2020 |website=U.S. Food and Drug Administration |date=22 December 2020 |url=https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-december-22-2020 |access-date=23 December 2020}} {{PD-notice}}</ref> It is not recommended in people who are at risk of high blood potassium or a history of [[myopathy]].<ref name=WHO2008/> Use during [[pregnancy]] appears to be safe for the baby.<ref>{{cite web|title=Prescribing medicines in pregnancy database|url=https://www.tga.gov.au/prescribing-medicines-pregnancy-database|website=Therapeutic Goods Administration (TGA)|access-date=16 December 2016|language=en|date=16 December 2016|url-status=live|archive-url=https://web.archive.org/web/20161220210434/https://www.tga.gov.au/prescribing-medicines-pregnancy-database|archive-date=20 December 2016}}</ref>

Suxamethonium is in the [[neuromuscular-blocking drugs|neuromuscular blocker]] family of medications and is of the [[depolarizing]] type.<ref name="AHFS2016" /> It works by blocking the action of [[acetylcholine]] on [[skeletal muscles]].<ref name="AHFS2016" /> <!-- Society and culture -->

Suxamethonium was described as early as 1906 and came into medical use in 1951.<ref name="Lee2009" /> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO21st">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free }}</ref> Suxamethonium is available as a [[generic medication]].<ref name="AHFS2016" />

==Medical uses==
[[File:Succhs.jpg|thumb|A vial of suxamethonium chloride]]

Succinylcholine chloride injection is [[Indication (medicine)|indicated]], in addition to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.<ref name="FDA PR 20201222" />

Its medical uses are limited to short-term muscle relaxation in [[anesthesia]] and intensive care, usually for facilitation of [[endotracheal intubation]]. It is popular in emergency medicine due to its rapid onset and brief duration of action. The former is a major point of consideration in the context of [[trauma care]], where endotracheal intubation may need to be completed very quickly. The latter means that, should attempts at endotracheal intubation fail and the person cannot be [[ventilator|ventilated]], there is a prospect for neuromuscular recovery and the onset of spontaneous breathing before [[hypoxemia|low blood oxygen levels]] occurs. It may be better than [[rocuronium]] in people without contraindications due to its faster onset of action and shorter duration of action.<ref>{{cite journal | vauthors = Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ | title = Rocuronium versus succinylcholine for rapid sequence induction intubation | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 10 | pages = CD002788 | date = October 2015 | pmid = 26512948 | pmc = 7104695 | doi = 10.1002/14651858.CD002788.pub3 }}</ref>

Suxamethonium is also commonly used as the sole [[muscle relaxant]] during [[electroconvulsive therapy]], favoured for its short duration of action.<ref name="pmid19222434">{{cite journal | vauthors = Lee C | title = Goodbye suxamethonium! | journal = Anaesthesia | volume = 64 | issue = Suppl 1| pages = 73–81 | date = March 2009 | pmid = 19222434 | doi = 10.1111/j.1365-2044.2008.05873.x | doi-access = free }}</ref>

Suxamethonium is quickly degraded by plasma [[butyrylcholinesterase]] and the duration of effect is usually in the range of a few minutes. When plasma levels of butyrylcholinesterase are greatly diminished or an atypical form is present (an otherwise harmless inherited disorder), paralysis may last much longer, as is the case in liver failure or in neonates.<ref name="Flower2011">{{cite book| vauthors = Rang HP, Dale MM, Ritter JM, Flower RJ, Henderson G |title=Rang and Dale's Pharmacology | edition = 7th |url= https://books.google.com/books?id=6Go5RQAACAAJ |date=25 March 2011 |publisher=Elsevier Science Health Science Division |isbn=978-0-7020-3471-8 |url-status=live|archive-url= https://web.archive.org/web/20170910183148/https://books.google.com/books?id=6Go5RQAACAAJ |archive-date=10 September 2017 }}</ref>

The vials are usually stored at a temperature between 2–8&nbsp;°C, but issues have been reported with lower storage temperatures.<ref name="pmid26787804">{{cite journal | vauthors = Dewachter P, Mouton-Faivre C | title = Frozen succinylcholine: the danger of being overzealous with its cold storage | journal = Br J Anaesth | volume = 116 | issue = 2 | pages = 299–300 | date = February 2016 | pmid = 26787804 | doi = 10.1093/bja/aev465 | doi-access = free }}</ref> The multi-dose vials are stable for up to 14 days at room temperature without significant loss of potency.<ref name="Quelicin FDA label">{{cite web | title=Quelicin- succinylcholine chloride injection, solution | work = DailyMed | publisher = U.S. National Library of Medicine  | date=15 February 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fb08161e-7711-406d-e7b3-ea4515c07983 | access-date=23 November 2020}}</ref> Unless otherwise indicated in the prescribing information, room temperature for storage of medications is {{convert|15|–|25|C|F}}.<ref>{{cite web |url=https://apps.who.int/medicinedocs/en/d/Js4885e/6.5.html|archive-url=https://web.archive.org/web/20110525092200/http://apps.who.int/medicinedocs/en/d/Js4885e/6.5.html|url-status=dead |archive-date=May 25, 2011 |title=Guidelines for the Storage of Essential Medicines and Other Health Commodities: 3. Maintaining the Quality of Your Products: Controlling temperature |department=apps.who.int |publisher=World Health Organization |access-date=2020-03-10}}</ref>

==Side effects==
[[Adverse drug reaction|Side effects]] include [[malignant hyperthermia]], muscle pains, acute [[rhabdomyolysis]] with [[hyperkalemia|high blood levels of potassium]],<ref name="Flower2011"/> transient [[ocular hypertension]], [[constipation]]<ref>{{cite book | vauthors = DiPiro JT, Talbert RL, Yee GC | title = Matzke Pharmacotherapy: A Pathophysiologicḣ Approach | edition = 6th | publisher = McGraw-Hill | date = 2005 | pages = 685 }}</ref> and changes in cardiac rhythm, including [[bradycardia|slow heart rate]], and [[cardiac arrest]]. In people with neuromuscular disease or [[burn]]s, an injection of suxamethonium can lead to a large release of [[potassium]] from [[skeletal muscles]], potentially resulting in cardiac arrest. Conditions having susceptibility to suxamethonium-induced high blood potassium are burns, [[closed head injury]], [[acidosis]], [[Guillain–Barré syndrome]], cerebral [[stroke]], [[drowning]], severe intra-abdominal [[sepsis]], massive [[Trauma (medicine)|trauma]], [[myopathy]], and [[tetanus]].

Suxamethonium does not produce [[unconsciousness]] or [[anesthesia]], and its effects may cause considerable psychological distress while simultaneously making it impossible for a patient to communicate. Therefore, administration of the drug to a conscious patient is contraindicated.{{medical citation needed|date=January 2020}}

===Hyperkalemia===
The side effect of high blood potassium may occur because the acetylcholine [[Cell surface receptor|receptor]] is propped open, allowing continued flow of potassium ions into the [[extracellular fluid]]. A typical increase of potassium ion serum concentration on administration of suxamethonium is 0.5&nbsp;[[mmol]] per [[liter]].The increase is transient in otherwise healthy patients. The normal range of potassium is 3.5 to 5 mEq per liter. High blood potassium does not generally result in adverse effects below a concentration of 6.5 to 7 [[mEq]] per liter. Therefore, the increase in serum potassium level is usually not catastrophic in otherwise healthy patients. Severely high blood levels of potassium can cause changes in [[cardiac electrophysiology]], which, if severe, can result in [[arrhythmia]]s and even [[cardiac arrest]].<ref name = StatPearls84>{{cite web | url=https://www.ncbi.nlm.nih.gov/books/NBK499984/ | pmid=29763160 | year=2022 | vauthors = Hager HH, Burns B | title=Succinylcholine Chloride | publisher=StatPearls }}</ref><ref>{{cite journal | vauthors = Martyn JA, Richtsfeld M | title = Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms | journal = Anesthesiology | volume = 104 | issue = 1 | pages = 158–169 | date = January 2006 | pmid = 16394702 | doi = 10.1097/00000542-200601000-00022 | s2cid = 4556150 | doi-access = free }}</ref>

===Malignant hyperthermia===
{{unreferenced section|date=January 2020}}
[[Malignant hyperthermia]] (MH) from suxamethonium administration can result in a drastic and uncontrolled increase in skeletal muscle [[oxidative metabolism]]. This overwhelms the body's capacity to supply [[oxygen]], remove [[carbon dioxide]], and regulate body temperature, eventually leading to circulatory collapse and death if not treated quickly.

Susceptibility to malignant hyperthermia is often inherited as an [[autosomal dominant]] disorder, for which there are at least six [[gene|genetic loci]] of interest, the most prominent being the [[ryanodine]] receptor gene (RYR1). MH susceptibility is [[phenotypically|phenotype]] and genetically related to [[central core disease]] (CCD), an autosomal dominant disorder characterized both by MH symptoms and by [[myopathy]]. MH is usually unmasked by [[anesthesia]], or when a family member develops the symptoms. There is no simple, straightforward test to diagnose the condition. When MH develops during a procedure, treatment with [[dantrolene]] sodium is usually initiated; dantrolene and the avoidance of suxamethonium administration in susceptible people have markedly reduced the mortality from this condition.

===Apnea===
{{See also|Pseudocholinesterase deficiency}}

The normal short duration of action of suxamethonium is due to the rapid metabolism of the drug by non-specific plasma cholinesterases. However, plasma cholinesterase activity is reduced in some people due to either genetic variation or acquired conditions, which results in a prolonged duration of neuromuscular block. Genetically, ninety six percent of the population have a normal (Eu:Eu) genotype and block duration; however, some people have atypical genes (Ea, Es, Ef) which can be found in varying combinations with the Eu gene, or other atypical genes (see [[Pseudocholinesterase deficiency]]). Such genes will result in a longer duration of action of the drug, ranging from 20 minutes up to several hours. Acquired factors that affect plasma cholinesterase activity include pregnancy, liver disease, kidney failure, [[heart failure]], [[thyrotoxicosis]], and cancer, as well as a number of other drugs.<ref>{{cite book | vauthors = Peck TE, Hill SA, Williams M | title = Pharmacology for Anaesthesia and Intensive Care | edition = 2nd | publisher = Greenwich Medical Media Limited | location = London, UK | date = 2003 | isbn = 1-84110-166-4 }}</ref>

If unrecognized by a clinician it could lead to awareness if anesthesia is discontinued whilst still paralyzed or hypoxemia (and potentially fatal consequences) if artificial ventilation is not maintained. Normal treatment is to maintain sedation and ventilate the patient on an intensive care unit until muscle function has returned. Blood testing for cholinesterase function can be performed.{{medical citation needed|date=January 2020}}

[[Mivacurium]], a non-depolarizing neuromuscular blocking drug, is also metabolized via the same route with a similar clinical effect in patients deficient in plasma cholinesterase activity.{{medical citation needed|date=January 2020}}

Deliberate induction of conscious apnea using this drug led to its use as a form of [[aversion therapy]] in the 1960s and 1970s in some prison and institutional settings.<ref>{{cite journal | vauthors = Reimringer MJ, Morgan SW, Bramwell PF | year = 1970 | title = Succinylcholine as a modifier of acting-out behavior | journal = Clinical Medicine | volume = 77 | issue = 7| page = 28 }}</ref><ref>{{cite news | author-link = Nicholas von Hoffman | vauthors = von Hoffman N | title = A Bit of 'Clockwork Orange,' California-Style | newspaper = Washington Post | date = 5 April 1972 | url = https://news.google.com/newspapers?nid=1755&dat=19720408&id=rLkqAAAAIBAJ&pg=7180%2C2668925 }}</ref><ref>{{cite book | vauthors = Sansweet RJ | date = 1975 | title = The Punishment Cure | location = New York | publisher = Mason/Charter | isbn = 0-88405-118-8 }}</ref> This use was discontinued after negative publicity concerning the terrifying effects on subjects of this treatment and ethical questions about the punitive use of painful aversion.{{citation needed|date=November 2014}}

==Mechanism of action==
There are two phases to the blocking effect of suxamethonium.

===Phase 1 block===
Phase 1 blocking has the principal paralytic effect. Binding of suxamethonium to the [[Muscle-type nicotinic receptor|nicotinic acetylcholine]] receptor results in opening of the receptor's [[cation|ion]] channel; a [[depolarization]] of the [[motor end-plate]] occurs and [[calcium]] is released from the [[sarcoplasmic reticulum]] leading to initial muscle contraction and [[fasciculation]]s.<ref name = "Appiah-Ankam_2004">{{cite journal | vauthors = Appiah-Ankam J, Hunter JM | title = Pharmacology of neuromuscular blocking drugs. | journal = Continuing Education in Anaesthesia Critical Care & Pain | date = February 2004 | volume = 4 | issue = 1 | pages = 2–7 | doi = 10.1093/bjaceaccp/mkh002 | doi-access = free }}</ref>

In normal skeletal muscle, [[acetylcholine]] dissociates from the receptor following depolarization and is rapidly hydrolyzed by [[acetylcholinesterase]]. The muscle cell is then ready for the next signal.<ref name = "Appiah-Ankam_2004" />

Suxamethonium is not hydrolyzed by acetylcholinesterase. By remaining bound to the acetylcholine receptor and maintaining the [[membrane potential]] above threshold, it does not allow the muscle cell to completely repolarize. This results in the inability for the voltage gated sodium channels to reset and instead are held in an inactive state leading to an inability to form further action potentials.<ref name = "Appiah-Ankam_2004" />

Voltage gated calcium channels likely close as the partially depolarised membrane potential remains between -30mV and -60mV, which is below the opening of the voltage gated calcium channel, approximately -10mV. Subsequently calcium is removed from the muscle cell [[cytoplasm]] . As the calcium is taken up by the sarcoplasmic reticulum, the muscle relaxes resulting in muscle [[flaccidity]].<ref>{{cite journal | vauthors = Pelizzari S, Heiss MC, Fernández-Quintero ML, El Ghaleb Y, Liedl KR, Tuluc P, Campiglio M, Flucher BE | title = Ca<sub>V</sub>1.1 voltage-sensing domain III exclusively controls skeletal muscle excitation-contraction coupling | journal = Nature Communications | volume = 15 | issue = 1 | pages = 7440 | date = August 2024 | pmid = 39198449 | doi = 10.1038/s41467-024-51809-5 | pmc = 11358481 }}</ref><ref>{{cite journal | vauthors = Gissen AJ, Nastuk WL | title = Succinylcholine and decamethonium: comparison of depolarization and desensitization | language = en-US | journal = Anesthesiology | volume = 33 | issue = 6 | pages = 611–618 | date = December 1970 | pmid = 5477644 | doi = 10.1097/00000542-197012000-00007 }}</ref>

The results are membrane depolarization and transient fasciculations, followed by flaccid paralysis.

===Phase 2 block===

{{more citations needed section|date=October 2023}}
While this phase is not abnormal and is a part of its mechanism of action, it is undesirable during surgery{{Citation needed|date=October 2023}}, due to the inability to depolarize the cell again.<ref name="Appiah-Ankam_2004" /> Often, patients must be on a ventilator for hours if Phase 2 block occurs.{{Citation needed|date=October 2023}} It generally occurs when suxamethonium is administered multiple times, or during an infusion occurring over too much time, but can also occur during an initial bolus if the plasma cholinesterase is abnormal<ref name="Appiah-Ankam_2004" /> Desensitization may occur at the nerve terminal causing the myocyte to become less sensitive to acetylcholine, resulting in the membrane repolarizing and being unable be depolarized again for a period of time.<ref name="Appiah-Ankam_2004" />

==Chemistry==
Suxamethonium is an odorless, white [[crystal]]line substance. Aqueous solutions have a [[pH]] of about 4. The [[dihydrate]] melts at 160&nbsp;°C, whereas the [[anhydrous]] melts at 190&nbsp;°C. It is highly soluble in water (1&nbsp;gram in about 1 mL), soluble in [[ethanol|ethyl alcohol]] (1&nbsp;gram in about 350 mL), slightly soluble in [[chloroform]], and practically insoluble in [[diethyl ether|ether]]. Suxamethonium is a [[hygroscopic]] compound.<ref>{{cite book | vauthors = Gennaro A | location = Remington | title = The Science and Practice of Pharmacy | edition = 20th | publisher = Lippincott Williams & Wilkins | date = 2000 | pages = 1336 }}</ref> The compound consists of two [[acetylcholine]] molecules that are linked by their [[acetyl]] groups. It can also be viewed as a central [[moiety (chemistry)|moiety]] of [[succinic acid]] with two [[choline]] moieties, one on each end.

==History==
Suxamethonium was first discovered in 1906 by [[Reid Hunt]] and René de M. Taveau.<ref>{{cite journal | vauthors = Hunt R, ((De M Taveau R)) |title=On the physiological action of certain cholin derivatives and new methods for detecting cholin |journal=The British Medical Journal |date=22 December 1906 |pages=1788-1791 |url=https://babel.hathitrust.org/cgi/pt?id=uiuo.ark:/13960/t5n94tj8n&seq=1850}}</ref> When studying the drug, animals were given [[curare]] and thus they missed the neuromuscular blocking properties of suxamethonium. Instead in 1949 an Italian group led by [[Daniel Bovet]] was first to describe succinylcholine induced paralysis. The clinical introduction of suxamethonium was described in 1951 by several groups. Papers published by Stephen Thesleff and Otto von Dardel in Sweden are important but also to be mentioned is work by Bruck, Mayrhofer and Hassfurther in Austria, Scurr and Bourne in UK, and Foldes in America.<ref name="pmid7047939">{{cite journal | vauthors = Dorkins HR | title = Suxamethonium-the development of a modern drug from 1906 to the present day | journal = Medical History | volume = 26 | issue = 2 | pages = 145–168 | date = April 1982 | pmid = 7047939 | pmc = 1139149 | doi = 10.1017/S0025727300041132 }}</ref>

==Abuse==

[[Dubai]] authorities declared that the [[Assassination of Mahmoud al-Mabhouh|assassination of Mahmoud Al-Mabhouh]], a [[Hamas]] operative, was carried out on their soil by [[Mossad]] agents with the use of suxamethonium chloride injection. Entering Dubai under false passports in 2010, the Mossad agents found al-Mabhouh at a hotel, immobilized him with the drug, electrocuted him, and suffocated him with a pillow. A high concentration of suxamethonium chloride was found in al-Mabhouh's body post-mortem. The incident triggered significant diplomatic crises in the Middle East, Europe, and Australia.<ref>{{cite web |url=https://abcnews.go.com/Blotter/dubai-hit-police-mahmoud-al-mabhouh-killed/story?id=9973592 |title=Dubai Hit: Police Say They Know How Mahmoud al-Mabhouh Was Killed |publisher=[[ABC News (United States)|ABC News]]}}</ref><ref>{{cite web |url=https://www.medgadget.com/2010/03/succinylcholine_a_perfect_poison_makes_appearance_in_the_dubai_murder.html|title=Succinylcholine, A Perfect Poison, Makes Appearance in the Dubai Killing | work = Medgadget |date=8 March 2010 }}</ref>

==Brand names==
It is available in German-speaking countries under the trade name Lysthenon among others.<ref>[https://compendium.ch/prod/pnr/29200/de?Platform=Desktop Compendium.ch: LYSTHENON 2% Inj Lös 100 mg/5ml]{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }} {{in lang|de}}</ref>

==Use in animals==
It is sometimes used in combination with [[analgesic|pain medication]]s and [[sedative]]s for [[euthanasia]] and immobilization of horses.{{Citation needed|reason=Suxamethonium paralyses a human or animal but the subject remains fully aware of pain and other distress. For this reason, it is illegal in the UK to give it to a human or animal without a second general anaesthetic (painkillers do not suffice).<ref>{{cite book |vauthors=Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Rang MP |title=Rang and Dale's Pharmacology |date=2020 |publisher=Elsevier Health Sciences |location=Edinburgh |isbn=978-0-7020-7448-6 |edition=Ninth |url=https://www.whsmith.co.uk/products/rang-and-dales-pharmacology-9th-revised-edition/james-m-ritter/rod-j-flower/paperback/9780702074486.html |access-date=2021-05-18 |archive-date=2021-05-18 |archive-url=https://web.archive.org/web/20210518231555/https://www.whsmith.co.uk/products/rang-and-dales-pharmacology-9th-revised-edition/james-m-ritter/rod-j-flower/paperback/9780702074486.html |url-status=dead }}</ref>|date=May 2021}}

== References ==
{{Reflist}}

{{Muscle relaxants}}
{{Nicotinic acetylcholine receptor modulators}}
{{Portal bar|Medicine}}

{{DEFAULTSORT:Suxamethonium Chloride}}
[[Category:Chemical substances for emergency medicine]]
[[Category:Chlorides]]
[[Category:Choline esters]]
[[Category:Lethal injection components]]
[[Category:Muscle relaxants]]
[[Category:Neuromuscular blockers]]
[[Category:Nicotinic agonists]]
[[Category:Quaternary ammonium compounds]]
[[Category:Succinate esters]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:World Health Organization essential medicines]]