Reference book of medicines. Application of the substance Suxamethonium chloride

Presented are analogues of the drug suxamethonium chloride, in accordance with medical terminology, called "synonyms" - drugs that are interchangeable in terms of effects on the body, containing one or more identical active substances. When choosing synonyms, consider not only their cost, but also the country of origin and the reputation of the manufacturer.

Description of the drug

Suxamethonium chloride- Depolarizing muscle relaxant of peripheral action. Causes blockade of neuromuscular transmission. Interacting with n-cholinergic receptors, causes depolarization of the end plate. The process extends to the adjacent membranes, a generalized disorganized contraction of myofibrils occurs (i.e., the development of the blockade is preceded by muscle twitches - the result of a short-term relief of neuromuscular transmission). The membranes, remaining depolarized, do not respond to additional impulses, since in order to maintain muscle tone the arrival of repeated impulses associated with repolarization of the end plate is required, spastic paralysis occurs. After intravenous administration, muscle relaxation occurs in the following sequence: muscles of the fingers, eyes, legs, neck, back; then intercostal muscles and diaphragm. Increases cerebral blood flow and intracranial pressure under general anesthesia.

After the / m administration, the action develops after 2-4 minutes; after intravenous administration - after 54-60 seconds, after 2-3 minutes, muscle relaxation reaches a maximum and remains in full for 3 minutes. Duration of action - 5-10 minutes. The severity of the action depends on the size of the administered dose: 100 mcg / kg - relaxation of skeletal muscles without a significant effect on respiratory system; 0.2-1 mg / kg - complete relaxation of the muscles of the abdominal wall and respiratory muscles (there is a significant limitation or complete cessation of spontaneous breathing). For prolonged muscle relaxation, repeated administration is necessary. The rapid onset of the effect and the subsequent rapid recovery of muscle tone allow you to create a controlled controlled relaxation of the muscles.

List of analogues

Note! The list contains synonyms of suxamethonium chloride, which have a similar composition, so you can choose a replacement yourself, taking into account the form and dose of the medicine prescribed by your doctor. Give preference to manufacturers from the USA, Japan, Western Europe, as well as well-known companies from Eastern Europe: Krka, Gedeon Richter, Actavis, Egis, Lek, Geksal, Teva, Zentiva.

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Official instructions for use

There are contraindications! Before use, read the instructions

LISTENON ®

(Listenon®)
Registration number
Tradename: LISTENON ®
International non-proprietary name:
Suxamethonium chloride
Dosage form:
solution for intravenous and intramuscular administration
Compound:
5 ml of the solution contains 113.3 mg of suxamethonium chloride dihydrate as the active substance and excipients (sodium chloride, water for injection).
Description: clear colorless solution.
Pharmacotherapeutic group:
muscle relaxant depolarizing peripheral action
ATC Code: M03AB01.
Pharmacodynamics
Short-acting peripheral muscle relaxant. Interacting with n-cholinergic receptors, it causes depolarization of the end plate of the synapse, which results in a blockade of neuromuscular transmission. At the beginning of the muscle relaxation process, muscle fasciculations may appear (the result of a short-term relief of neuromuscular transmission). Muscle relaxation occurs in the following sequence: eyelids, chewing muscles, limb muscles, abdominal muscles, muscles vocal cords and diaphragm. The process of depolarization does not stop under the influence of cholinesterase inhibitors (for example, neostigmine).
LISTENON ® differs from long-acting muscle relaxants by fast and short-term action. With intravenous administration, the action develops after 30-60 seconds and lasts 2-6 minutes. When administered intramuscularly, the action begins after 75 seconds - 3 minutes in adults and 3.5 minutes in children and lasts 30 minutes in adults and 21 minutes in children. This makes it possible to achieve the necessary degree of muscle relaxation during such operations, when prolonged relaxation of the striated muscles is not required.
In rare cases, a prolonged muscle relaxant effect may occur if LISTENON ® (dose 3-5 mg/kg body weight) is administered fractionally for a long time (double blocking). In this phase, the action of LISTENONE ® can be neutralized by neostigmine.

Pharmacokinetics

After intravenous administration, it is distributed in plasma and extracellular fluid. More than 90% is hydrolyzed by serum cholinesterase to choline and succinylmonocholine. without pharmacological activity. The elimination half-life is 90 seconds at normal cholinesterase levels. Excreted by the kidneys (10% unchanged). Does not penetrate the intact blood-brain barrier. Does not accumulate.

Indications for use

Conditions requiring short-term relaxation of skeletal muscles, including endotracheal intubation before surgery, reduction of dislocations, reduction of displaced fractures, prevention of spontaneous injuries during electroshock therapy.

Contraindications

Hypersensitivity to suxamethonium chloride, severe hepatic dysfunction, pulmonary edema, severe hyperthermia, malignant hyperthermia (history), decreased plasma cholinesterase, hyperkalemia or risk of hyperkalemia after multiple injuries (5-90 days), severe burns, penetrating eye damage, diseases with impaired neuromuscular transmission, children under 1 year old, patients with uremia, especially with high level serum potassium. Pregnancy and lactation.
Carefully: patients with heart disease, children from 1 year of age (see special instructions), narrow-angle glaucoma.

Dosage and administration

Intravenously by stream or in the form of infusions, intramuscularly. For long-term drip infusion, a 0.1% solution of LISTENONE ® is used. The dosage depends on the desired degree of muscle relaxation, body weight and individual sensitivity of the patient.
With the introduction of LISTENON ® 0.1 mg/kg, relaxation of the skeletal muscles is observed without respiratory depression. A dose of 0.2 mg/kg to 1.0 mg/kg leads to complete relaxation of the muscles of the abdominal wall and skeletal muscles and, in the future, to the limitation or complete cessation of spontaneous breathing. If intravenous administration is not possible, up to 2.5 mg / kg of body weight is prescribed intramuscularly, maximum 150 mg. The onset of muscle relaxation with intramuscular injection may be slightly delayed.
Children should be used only if absolutely necessary (see Special Instructions). The dosage for children is: 1-2 mg/kg body weight intravenously or up to 2.5 mg/kg intramuscularly.
Intravenous drip administration: depending on the patient's body weight and the desired degree of muscle relaxation, the dose for adults is 0.5 mg - 5 mg / min in the form of a 0.1-0.2% solution.
LISTENON ® is compatible with isotonic solutions of sodium chloride, Ringer's, 5% dextrose and 6% dextran.
Ampoules with a break line No filing required Ampoule position in hands Colored dot on top! Shake the ampoule to remove the solution from the tip of the ampoule.
Color dot on top! Break the tip of the ampoule down.

Side effects

Tachycardia or bradycardia, arrhythmia, ventricular fibrillation, decrease or increase blood pressure, increased intraocular pressure, spasm of the bronchi or larynx, increased salivation, myoglobinuria. muscle stiffness, postoperative muscle pain, malignant hyperthermia, increased intragastric and intracranial pressure, "double" block.
The reasons for the increase in muscle relaxation time, including with apnea, may be a deficiency of blood serum cholinesterase (including hereditarily caused).

Overdose

Symptoms: increased severity side effects, stop breathing. Treatment: transfusion of whole blood or banked plasma, artificial respiration with intermittent positive pressure. Transfer to "double blocking" followed by the use of neostigmine.

Interaction with other drugs

Pharmaceutical:
Mixing LISTENONE ® with drugs that have an alkaline environment, (for example, with barbiturates) may lead to the absence of the effect of LISTENONE ® .
Pharmacodynamic and pharmacokinetic:
The preliminary administration of LISTENON ® enhances the effect of non-depolarizing relaxants. Pre-administration of non-depolarizing relaxants reduces or prevents the occurrence of adverse reactions of LISTENONE ® . Adverse reactions associated with circulatory disorders increase when taking halogenated drugs (halothane), weaken when taking thiopental and atropine.
The muscle relaxant effect of LISTENON ® is enhanced by antibiotics such as aminoglycosides or polypeptides, amphotericin B, cyclopropane, propanidide, quinidine and thiotepa. parasympathomimetics, including cholinesterase inhibitors. Aimaline, beta-blockers, calcium channel blockers, cyclophosphamide, thiophosfamide, oxytocin, cimetidine, metoclopramide, phenothiazine. lithium preparations and oral contraceptives.
The simultaneous use of inhalation anesthetics should be avoided, as this increases the risk of malignant hyperthermia and increases the neuromuscular block associated with the use of LISTENON ® .
Suxamethonium chloride enhances the effect of digitalis preparations (risk of arrhythmia).
Simultaneous infusion of whole blood or plasma weakens the effect of LISTENON ® .

special instructions

There are reports of cases of irreversible cardiac arrest after the use of suxamethonium chloride in children and adolescents who had previously undetectable neuromuscular diseases. Due to the risk of side effects, it is recommended to limit the use of suxamethonium chloride even in apparently healthy children and adolescents, except in those cases that require immediate intubation or release. respiratory tract V critical situations.
LISTENON ® , like all muscle relaxants of peripheral action, can only be prescribed by doctors who have experience working with devices artificial respiration and the skills to perform intratracheal intubation and to have positive pressure ventilators ready for use, as well as devices that provide sufficient oxygen supply and carbon dioxide removal.
To prevent severe bradycardia, bronchospasm or other muscarinic effects, it is recommended to administer atropine before taking LISTENON ®.

Release form

Solution for intravenous and intramuscular administration 20 mg/ml. 5 ml in colorless hydrolytic glass ampoules (type 1, Evr.pharm.) with a break point. 5 ampoules in a plastic blister pack. 1 blisters with instructions for use in a cardboard box.

Storage conditions

Storage at a temperature of 2-8 ° C in a place protected from light. Keep out of the reach of children!

Best before date

3 years. Do not use after the expiration date stated on the packaging.
Vacation from the pharmacy
On prescription. Only for hospitals and specialized departments.
Manufacturer:

"Nycomed Austria GmbH", Austria.
St. Peter-Straβe 25. A-4020 Linz, Austria.
Art. Peterstrasse 25, A-4020 Linz, Austria.
Address of representative office in Russia / CIS
119021 Moscow, st. Timur Frunze, 24.

The information on the page was verified by the therapist Vasilyeva E.I.

Short acting depolarizing muscle relaxant. Causes blockade of neuromuscular transmission and relaxation of skeletal muscles. Rapidly hydrolyzed by serum cholinesterase. After its introduction, muscle relaxation occurs in the following sequence: the muscles of the fingers, eyes, legs, neck, back, then the intercostal muscles and the diaphragm. It has a quick and short action, does not accumulate in the body. The short latency period and the subsequent complete recovery of muscle tone allow for controlled relaxation of the skeletal muscles. Under the action of pseudocholinesterase, suxamethonium chloride decomposes to form choline and succinic acid.
The action of suxamethonium chloride develops immediately after administration, approximately 2-3 minutes after injection, relaxation of skeletal muscles reaches a maximum and lasts about 3 minutes. Approximately 5 minutes after the injection, muscle relaxation stops. A tenfold dose (200 mg) causes complete paralysis with respiratory muscle shutdown lasting about 8 minutes without side effects or aftereffects. Suxamethonium chloride allows you to maintain controlled muscle relaxation during surgical interventions, especially when used as an intravenous infusion. Complete restoration of neuromuscular conduction is observed in the near future after the cessation of its administration.

Indications for use of the drug Suxamethonium chloride

Tracheal intubation, endoscopic examinations (broncho- and esophagoscopy, cystoscopy, etc.); reduction of dislocations, reposition of bone fragments in fractures; convulsions with tetanus, strychnine poisoning; prevention of spontaneous injuries during electropulse therapy; short-term surgical interventions requiring muscle relaxation.

Application of the drug Suxamethonium chloride

The introduction of suxamethonium chloride is permissible only if all the conditions for performing mechanical ventilation are present, and when used in high doses, after the patient is transferred to controlled breathing. The dose is set individually depending on the indications, body weight and the patient's response. Enter / in slowly. For intubation and complete relaxation of the skeletal and respiratory muscles, 1.5-2 mg / kg is administered. For long-term muscle relaxation, it can be administered fractionally after 5-7 minutes at a dose of 0.6-1 mg/kg.

Contraindications to the use of the drug Suxamethonium chloride

Acute liver failure, myasthenia gravis, glaucoma, penetrating eye injuries, severe anemia, extensive burns and wounds, pseudocholinesterase deficiency, simultaneous administration of blood products, hypersensitivity to suxamethonium; not prescribed to infants.

Side effects of the drug Suxamethonium chloride

There may be a violation of the excitability and conduction of the myocardium, myalgia (especially in the muscles chest and abdomen), increased intraocular pressure, impaired liver function, hyperglycemia, anaphylactic shock, collapse, sometimes - hypertension (hypertension), bradycardia, asystole, in case of overdose - short-term respiratory arrest.

Special instructions for the use of the drug Suxamethonium chloride

Caution should be used in severe liver disease, anemia, cachexia, during pregnancy (suxamethonium chloride crosses the placental barrier).
Slow administration of suxamethonium chloride, as well as intravenous premedication with atropine at a dose of 1-1.5 mg, largely prevents the development of bradycardia.
With repeated administration, excessive prolonged muscle relaxation and apnea may develop. The reasons for this are hypercapnia, acidosis, hypovolemia, hypokalemia, a decrease in the level of pseudocholinesterase, and deep anesthesia. In some cases, there is an overreaction with prolonged respiratory depression. This is due to a genetic disorder in the formation of cholinesterase. If the function of external respiration is not restored after 25-30 minutes, prozerin and other anticholinesterase agents are administered: first, atropine is administered intravenously (0.5-0.7 ml of 0.1% solution) and against the background of tachycardia after 1-2 min intravenously injected 1.5 mg of prozerin (3 ml of 0.05% solution). If the effect is insufficient, prozerin in the same dose is administered repeatedly.
10-12 hours after the use of suxamethonium chloride, pain may appear in skeletal muscles. Preliminary (1 min before the administration of suxamethonium) administration of 3-4 mg of d-tubocurarine prevents the occurrence of myalgia and fibrillar muscle twitching.

In medical practice, a number of drugs are used, which are necessary, for example, to bring the patient's body into the state required for performing a surgical intervention. Certain procedures require artificially induced absolute muscle relaxation. For this purpose, the drug "Suxamethonium chloride" is often used (the trade name of the drug is "Listeon"). This medication is mostly used in specialized medical institutions. What is the essence of its pharmacological action? Is it dangerous to use the agent in question? What should be prepared for when using the substance "Suxamethonium chloride"? Description of the drug and some features of its use will be discussed later in this article.

Compound

The main active ingredient of the drug in question is suxamethonium chloride. Also, the composition of the drug includes such auxiliary components as ethylenediaminetetraacetic acid disodium salt or disodium edetate, as well as water for injection.

Release form

"Suxamethonium chloride", as a rule, is produced by manufacturers in the form of a solution (for both intramuscular and intravenous administration).

pharmachologic effect

The drug in question is a depolarizing muscle relaxant. Its action is short-lived. The active components of the drug effectively block neuromuscular transmission.

Muscle relaxation always occurs in the same sequence, which must be taken into account by medical personnel. So, it begins with the muscles of the eyelids, then affects the chewing muscles and the muscles of the fingers, eyes and all limbs. Then muscle relaxation reaches the neck area, the muscles of the back, abdomen and vocal cords relax. The last to react to the action of the drug are the intercostal muscles and the diaphragm.

If the medicine was administered intramuscularly, then it will begin to act after two to four minutes, and if intravenously, already after a minute. Maximum muscle relaxation occurs three minutes after the administration of the drug. This action lasts for five to ten minutes, depending on the dose of the substance.

The drug is evenly distributed in blood plasma and extracellular fluid after a short time after the introduction of the solution (subject to intravenous administration). About ninety percent of the substance is hydrolyzed, transforming into choline or succinic acid. Provided that the concentration of cholinesterase in the blood is maintained at a sufficient level, the half-life of the drug is only ninety seconds. The substance is fully excreted by the kidneys (including ten percent - unchanged).

Indications for use

The drug in question is used in cases where an intervention is required that requires complete relaxation of the muscles. These conditions include bronchoscopy, endoscopy, abdominal surgery, reduction of fractures, reduction of dislocations, and endotracheal intubation.

Mode of application

The substance "Suxamethonium chloride" can be administered intramuscularly and intravenously (both drip and jet). For this method of application, a 0.1% solution of the substance is used. The working dose in which suxamethonium chloride and iodide are used is prescribed individually by a specialist in accordance with the individual characteristics of a particular patient and, as a rule, with intravenous administration ranges from 0.1 to 2 milligrams per kilogram, and with intramuscular injection - from 3 to 4 micrograms per kilogram. In this case, in general, for the course of treatment, the total volume of the administered substance should not exceed one hundred and fifty micrograms.

Contraindications

Some patients should never receive Suxamethonium Chloride. Instructions for use of this drug informs about the following contraindications to the use of the drug: individual hypersensitivity to any of the constituent components of the drug, myasthenia gravis, bronchial asthma, angle-closure glaucoma, pulmonary edema, hyperkalemia, acute liver failure, congenital and dystrophic myotonia, cholinesterase deficiency, mechanical eye injury. It is also forbidden to use the medicine in question for children under one year old and for women during the period of bearing a child or breastfeeding.

Side effects

In rare cases, "Suxamethonium chloride" (solution for injection) can cause a number of unpleasant symptoms and manifestations from various body systems. Among them are various kinds of allergic reactions (for example, bronchospasm and anaphylactic shock), paralysis of the respiratory muscles (occurs if there are genetic disorders in the formation of serum cholinesterase), arrhythmia, myalgia, fever, bradycardia, hyperkalemia, hypersalivation, cardiogenic shock, lowering blood pressure, impaired conduction, increased intraocular pressure. In order to avoid the occurrence of the above problems, it is important to strictly adhere to the recommendations regarding the use of the drug "Suxamethonium chloride". Analogues of the drug (at least some of them) have a much smaller number of side effects. Therefore, sometimes it would be wise to turn to them.

Overdose

In case of unintentional or deliberate excess of the recommended dose of the drug, some undesirable consequences for the patient's body may occur. The most dangerous of these is respiratory arrest. In this case, one cannot do without the help of specialists, otherwise a fatal outcome is possible. Urgent ventilation is required. Sometimes the level of cholinesterase in the blood serum drops sharply. Some experts recommend a fresh blood transfusion or, often safer, blood substitutes to treat this condition.

Special Instructions

It is recommended to administer high-quality non-depolarizing muscle relaxants one minute before the administration of the drug "Suxamethonium chloride". The description of the substance contains information that such an interaction eliminates the risk of subsequent manifestation of myalgia and muscle twitches. It is important to use the drug only in specialized departments of medical institutions, subject to the availability of the necessary equipment (including a ventilator) and competent personnel able to properly use this technique and make decisions in stressful situations. Since the use of the agent in question can cause bradycardia in the patient, it is recommended to administer the drug "Atropine" to the patient before using "Suxamethonium chloride".

Possibility of combination with other drugs

When using other medicines simultaneously with the drug in question, attention should be paid to whether such an interaction is permissible. "Suxamethonium chloride" instructions for use do not recommend the use in parallel with antimyasthenic drugs, as it significantly reduces the effectiveness of their action. The drug in question also enhances the pharmaceutical effect of glycosides. In no case should "Suxamethonium chloride" be used simultaneously with donor blood, as it provokes a hydrolysis reaction, any blood products, alkaline solutions and barbiturate solutions (contributes to precipitation).

Influence on the ability to concentrate attention (driving vehicles and complex mechanisms)

"Suxamethonium chloride" has a significant effect on the ability to concentrate and maintain attention. This means that in order to avoid accidents, it is necessary to avoid driving vehicles and any other activities that pose a threat to human life and health and require increased concentration, as well as fast response and instant decision-making on the first day after the termination of the drug in question.

Storage conditions and shelf life

You can store "Suxamethonium chloride" under strictly defined conditions. Namely: the temperature in the place of storage should range from two to eight degrees Celsius. The drug should be located out of reach for children. The maximum shelf life of the medicinal product is three years from the date of its manufacture. After the specified period, it is not recommended to use the drug, because in this case it loses its beneficial features and may be dangerous to the patient.

The safety of the patient, the safety of his life is the responsibility of the doctors who treat him. Therefore, it is important that the heads of medical institutions make sure that the personnel of these institutions are competent in the use of drugs, the side effects of these drugs, and methods for eliminating the adverse reactions that have arisen. Similarly, hospital staff must have the necessary knowledge and skills to properly use the equipment at their disposal that can save a patient's life. This is especially true for drugs whose possible side effects can threaten the onset lethal outcome. It is to this group of drugs that "Suxamethonium chloride" belongs. Therefore, it should be used only if competent specialists who are able to use a ventilator are present during the procedure. This may be necessary if an adverse reaction such as respiratory arrest occurs. In this case, the coherence of the actions of doctors and their professional competence will be the decisive factors that will determine whether the patient will survive.

Sometimes doctors, for certain reasons (if there are some contraindications), decide to use a different muscle relaxant - an analogue of "Suxamethonium chloride" (for example, "Ditilin", which cannot be used only in the presence of glaucoma). It is important to trust the authoritative opinion of experts in this matter. Therefore, you should be sure of the professional competence of the doctor with whom you are cooperating.

Before you opt for the drug in question, you should learn everything about the substance "Suxamethonium chloride": trade name, analogues, contraindications, possible side effects, features of use and recommended dosages. The patient must also be well versed in what kind of medicine is administered to him. "Listenone" ("Suxamethonium chloride") is the trade name for the substance in question. Therefore, when you hear this name from the lips of a doctor, you will understand well how it will act in your body. This knowledge is necessary in order not to put your life at unnecessary risk. It is important to be as careful as possible about which drugs are given to you during treatment.

Trust your health only to professionals, choose the best qualitative methods treatments and the best drugs! Take care of yourself!

Suxamethonium chloride is a drug that belongs to the group of depolarizing peripheral muscle relaxants, designed to prepare the patient for diagnostic and therapeutic procedures, as well as for the treatment of certain diseases. Especially for readers of “Popular about Health”, I will consider the description of this remedy.

So, the instruction of Suxamethonium chloride:

Composition of Suxamethonium chloride and release form

The active ingredient of the drug Suxamethonium chloride is represented by the medicinal substance of the same name, in the amount of 20 milligrams per milliliter. Excipients: water for injection, sodium chloride, and Trilon B.

The drug Suxamethonium chloride is available as a slightly yellowish solution, sold in ampoules of 5 milliliters. The medicine is dispensed by prescription, in packs of 10 and 5 pieces.

Pharmacological action Suxamethonium chloride

Short-acting peripheral muscle relaxant. The effect of the drug is based on the ability of the active substance to suppress the processes of transmission of the neuromuscular impulse, which leads to the development of a disorganized contraction of muscle fibers.

Being in a state of so-called disorganized contraction muscle fibers cease to respond to electrical impulses from the central nervous system, which leads to the development of reversible paralysis of the skeletal muscles of the spastic type.

The action of the drug develops very quickly. With intravenous administration of the drug, the muscle relaxant effect occurs after a minute, with intramuscular injection - after 3 minutes. The duration of exposure does not exceed 5 - 10 minutes.

The muscle relaxant action develops in a strict sequence. First, spastic paralysis affects the muscles of the eyelids and chewing muscles. Next - fingers, limbs, neck, back, abdomen, vocal cords. Last but not least - the intercostal muscles and the diaphragm (paralysis of the respiratory muscles).

When using the drug at a dosage of 0.1 milligrams per kilogram, paralysis does not affect the respiratory muscles. A dosage of 0.2 mg per kg leads to the development of respiratory paralysis.

Metabolization of the active substance is carried out directly in the blood plasma, under the action of plasma pseudocholinesterases. Derivatives of suxamethonium chloride are excreted in the urine.

Suxamethonium chloride indications for use

The use of the muscle relaxant Suxamethonium chloride is indicated in the following cases:

Conducting bronchoscopy;
Implementation of intratracheal intubation;
Muscle relaxation for reduction of dislocations, fractures and so on;
Prevention of the development of convulsive syndrome with electropulse therapy;
Tetanus;
Strychnine poisoning.

The expediency of prescribing the drug is determined by the attending physician. Any use without professional supervision is life-threatening and can lead to irreversible consequences.

Contraindications Suxamethonium chloride for use

The use of the drug Suxamethonium chloride is contraindicated in the following cases:

Bronchial asthma;
Penetrating eye injury;
Dystrophic myotonia;
Myasthenic conditions;
malignant hyperthermia;
kidney failure;
Pulmonary edema;
lactation period;
Cholinesterase deficiency;
Hyperkalemia (high potassium content);
Pregnancy;
Intolerance to suxamethonium chloride or excipients;
Age less than a year.

Relative contraindications: anemic conditions, infectious diseases, malignant neoplasms, insecticide intoxication, collagen diseases, myxedema.

Application of Suxamethonium chloride and dosage

Suxamethonium chloride is intended for intravenous or intramuscular administration. For an adult patient, the drug is indicated in a dosage of one and a half to 2 milligrams per kilogram of weight. The maximum dose is 150 mg.

In pediatric practice, the dosage regimen is determined by the age, diagnosis and body weight of the patient. The choice of an effective dose is up to the physician and can range from 100 micrograms to 2 milligrams per kilogram of body weight.

The choice of dosage and method of administration of the drug is entirely in the hands of a specialist. However, it should be remembered that repeated administration may lead to the development of a longer therapeutic effect, due to a decrease in the activity of plasma pseudocholinesterases. This circumstance must be taken into account.

Overdose of suxamethonium chloride

The main and most dangerous symptom of an overdose of the drug is the stoppage of spontaneous respiratory activity. Treatment consists of immediately connecting the patient to a ventilator. In addition, to accelerate the processes of metabolism of the active substance, transfusion of blood plasma is indicated.

Side Effects of Suxamethonium Chloride

The introduction of the muscle relaxant Suxamethonium chloride can lead to the development of the following side effects: bronchospastic phenomena, anaphylactic shock, increased potassium in the blood, increased intraocular pressure, paralysis of the respiratory muscles, lowering blood pressure, disorders heart rate, muscle pain, fever, increased saliva.

Analogues Suxamethonium chloride

Chlorsuccillin, Ditilin-A, Listenon, Myo-relaxin.

Conclusion

The drug can be used only in a stationary medical institution and is required in the presence of equipment for artificial ventilation of the lungs. In addition, the physician must have the necessary experience in handling such pharmaceuticals.

Suxamethonium chloride (Suxamethonium chloride)

Group:

Active ingredients:

Dosage form:

solution for intravenous and intramuscular administration

Pharmachologic effect:

Short acting depolarizing muscle relaxant. Causes blockade of neuromuscular transmission. Interacting with n-cholinergic receptors, causes depolarization of the end plate. The process extends to the adjacent membranes, a generalized disorganized contraction of myofibrils occurs (i.e., the development of the blockade is preceded by muscle twitches - the result of a short-term relief of neuromuscular transmission). The membranes, remaining depolarized, do not respond to additional impulses, since repeated impulses associated with repolarization of the end plate are required to maintain muscle tone, spastic paralysis occurs. After intravenous administration, muscle relaxation occurs in the following sequence: eyelid muscles, chewing muscles, muscles of the fingers, eyes, limbs, neck, back and abdomen, vocal cords; then intercostal muscles and diaphragm. Increases cerebral blood flow and intracranial pressure under general anesthesia. After the / m administration, the action develops after 2-4 minutes; after intravenous administration - after 54-60 s, after 2-3 minutes, muscle relaxation reaches a maximum and remains in full for 3 minutes. Duration of action - 5-10 minutes. The severity of the action depends on the size of the administered dose: 0.1 mg / kg - relaxation of the skeletal muscles without a significant effect on the respiratory system, 0.2-1 mg / kg - complete relaxation of the muscles of the abdominal wall and respiratory muscles (there is a significant limitation or complete cessation of spontaneous breathing). For prolonged muscle relaxation, repeated administration is necessary. The rapid onset of the effect and the subsequent rapid recovery of muscle tone allow you to create controlled and controlled muscle relaxation.

Indications:

Interventions requiring muscle relaxation (usually short-term): turning off spontaneous breathing (intratracheal intubation, bronchoscopy); complete muscle relaxation (endoscopy, reduction of dislocations, reduction of fractures, gynecological, thoracic, abdominal operations); prevention of seizures during electropulse therapy; strychnine poisoning, tetanus (symptomatic therapy).

Contraindications:

Hypersensitivity, malignant hyperthermia (including history), myasthenia gravis, congenital and dystrophic myotonia, Duchenne muscular dystrophy, angle-closure glaucoma, acute liver failure, pulmonary edema, penetrating eye injury, bronchial asthma, hyperkalemia, infancy (up to 1 year ), pregnancy. With caution. Emergency surgery in patients with a "full stomach", decreased serum cholinesterase activity (end-stage liver failure), anemia, cachexia, prolonged fasting, chronic infections, widespread burns, trauma, postpartum period, tetanus, tuberculosis, malignant neoplasms, chronic renal failure, myxedema, collagen diseases, conditions after plasma transfusion, plasmapheresis, cardiopulmonary bypass, acute or chronic intoxication with insecticides - cholinesterase inhibitors (when ingested) or anticholinesterase drugs (neostigmine, physostigmine, distigmine, phospholine) , simultaneous reception of drugs that compete with suxamethonium for cholinesterase (for example, procaine in / in).

Side effects:

Allergic reactions (anaphylactic shock, bronchospasm); hyperkalemia, decreased blood pressure, arrhythmias, bradycardia (more often in children, with repeated administration - in children and adults), conduction disturbances, cardiogenic shock; increased intraocular pressure, hypersalivation, fever; myalgia (in the postoperative period); prolonged paralysis of the respiratory muscles (associated with a genetically determined violation of the formation of serum cholinesterase); rarely - rhabdomyolysis with the development of myoglobinemia and myoglobinuria. Overdose. Symptoms: respiratory arrest. Treatment: IVL, in case of a decrease in serum cholinesterase - fresh blood transfusion.

Dosage and administration:

In / in (stream, drip), in / m. Adults: in / in slowly, by stream or drip (for long-term drip infusion, a 0.1% solution is used). Depending on the clinical situation with intravenous administration, a single dose varies from 0.1 to 1.5-2 mg / kg. V / m - 3-4 mg / kg, but not more than 150 mg. V / m is used in children in doses up to 2.5 mg / kg, but not more than 150 mg, in / in - 1-2 mg / kg. For tracheal intubation - 0.2-0.8 mg / kg; for muscle relaxation and switching off spontaneous breathing - 0.2-1 mg / kg; for relaxation of skeletal muscles during reduction of dislocations and reposition of bone fragments in fractures - 0.1-0.2 mg / kg; for endoscopy and EEG - 0.2 mg / kg; for the prevention of complications during electrical impulse therapy (convulsions, avulsion of muscles and tendons) - 0.1-1 mg / kg IV and up to 2.5 mg / kg IV, but not more than 150 mg. For long-term relaxation of the muscles during the entire operation, it can be administered fractionally, after 5-7 minutes, at a dose of 0.5-1 mg/kg. Repeated doses last longer.

Special instructions:

Introduction 1 min before suxamethonium chloride 3-4 mg of d-tubocurarine or 10-15 mg of diplacin almost completely prevents muscle twitching and subsequent myalgia. With an appropriate dose and repeated administration, it can also be used for longer operations, however, for prolonged muscle relaxation, non-depolarizing muscle relaxants are usually used, which are administered after preliminary tracheal intubation against the background of suxamethonium. They are used only in the conditions of a specialized department in the presence of equipment for artificial ventilation of the lungs and personnel who own this equipment, and against the background of general anesthesia. To prevent severe bradycardia, increase bronchial secretion, and other effects associated with m-anticholinergic action, it is recommended to administer atropine before the administration of suxamethonium. Patients with renal insufficiency (without signs of hyperkalemia and neuropathy) are administered once at medium doses, but are not used for multiple injections or at higher doses due to the risk of hyperkalemia. Protracted muscle relaxation with possible apnea can be caused by several reasons: "atypical" serum cholinesterase, hereditary deficiency of serum cholinesterase or a temporary decrease in its concentration in severe liver disease, severe anemia, after prolonged fasting, with cachexia, dehydration, febrile conditions, after acute poisoning or chronic exposure to insecticides - cholinesterase inhibitors (when ingested) or anticholinesterase drugs (neostigmine, physostigmine, distigmine, phospholine), as well as with the simultaneous use of drugs that compete with suxamethonium for cholinesterase (for example, procaine in / in). With prolonged administration at doses of 3-5 mg/kg, the so-called "double block" may develop - a prolonged curare-like effect, which can be eliminated by neostigmine.

Interaction:

Enhances the effects of cardiac glycosides. Reduces the effectiveness of antimyasthenic drugs. Pharmaceutically incompatible with donor blood (hydrolysis occurs), blood preservatives, serum preservatives, blood products, barbiturate solutions (precipitation forms) and alkaline solutions. Compatible with 0.9% NaCl solution, Ringer's solution, 5% fructose solution and 6% dextran solution. Anticholinesterase drugs, procaine, procainamide, lidocaine, verapamil, beta-blockers, aminoglycoside antibiotics, amphotericin B, clindamycin, cyclopropane, propanidide, organophosphorus insecticides, Mg2+ and Li+ salts, quinidine, quinine, chloroquine, pancuronium, increase and lengthen muscle relaxation shaping action. Compatible with other muscle relaxants, narcotic analgesics. Halogen-containing drugs for general anesthesia increase, and sodium thiopental and atropine reduce the undesirable effect on the cardiovascular system. Drugs with the potential ability to reduce the activity of blood cholinesterase (aprotinin, diphenhydramine, promethazine, estrogens, oxytocin, corticosteroids in high doses, oral contraceptives) increase and prolong the muscle relaxant effect of suxamethonium.

Before using the drug Suxamethonium chloride consult your doctor!