Succinylcholine Injection Shortage

• • Anectine injection, Sandoz, 20 mg/mL, 10 mL vial, 10 count, NDC 00781-3009-95

• • Hospira has a consistent supply of Quelicin injection.[1]
  • Sandoz discontinued Anectine in September 2015.[2]

• • Quelicin injection, Pfizer, 20 mg/mL, 10 mL vial, 25 count, NDC 00409-6629-02

Estimated Resupply Dates

• • All marketed presentations are currently available.

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  • Centers should make any operational changes necessary so that supplies of succinylcholine do not become outdated because of room temperature storage.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.[3,4,5]
  • 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.[3,4,5]

  Table 1. Characteristics of NMBAs3,4,5

  NMBA	Type of NMBA	Onset of Action (minutes)	Clinical Duration After Initial Dose (minutes)
  Atracurium	Nondepolarizing	2 to 3	20 to 35
  Cisatracurium	Nondepolarizing	1.5 to 2	20 to 35
  Pancuronium	Nondepolarizing	2 to 3	60 to 100
  Rocuronium	Nondepolarizing	1 to 2	22 to 67 (depending on initial bolus dose)
  Succinylcholine	Depolarizing	0.5 to 1	4 to 6
  Vecuronium	Nondepolarizing	2.5 to 3	20 to 40

  
  

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, September 29, December 31, 2014; January 9, March 9, May 11, July 13 and 15, September 8 and November 11, 2015.
  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, September 29, December 27, 2014; March 9, May 11, July 16, September 11 and November 11, 2015.
  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.