Details of the Drug

General Information of Drug (ID: DM2ET1M)

• Drug Name: Succinylcholine
• Synonyms: Anectine; Diacetylcholine; Ditilin; Ditiline; Listenon; Lysthenon; Quelicin; SCK; Succicuran; Succinocholine; Succinoylcholine; Succinylbischoline; Succinyldicholine; Sucostrin; Suxamethonium; Dicholine succinate; Succinyl choline; Anectine (TN); Scoline (TN); Succinic acid, diester with choline; Succinic acid, diester with choline chloride; Choline, succinate (ester); Choline, succinate (2:1) (ester); Trimethyl-[2-[4-oxo-4-(2-trimethylazaniumylethoxy)butanoyl]oxyethyl]azanium diio; Trimethyl-[2-[4-oxo-4-[2-(trimethylazaniumyl)ethoxy]butanoyl]oxyethyl]azanium; 2,2'-[(1,4-DIOXOBUTANE-1,4-DIYL)BIS(OXY)]BIS(N,N,N-TRIMETHYLETHANAMINIUM)

Indication

Disease Entry	ICD 11	Status	REF
Plasma cell myeloma	2A83.1	Approved	[1]
Spasm	MB47.3	Approved	[2]

• Therapeutic Class: Analgesics
• Drug Type: Small molecular drug
• #Ro5 Violations (Lipinski): 1:
  Molecular Weight (mw); 290.4
  Logarithm of the Partition Coefficient (xlogp); 0.6
  Rotatable Bond Count (rotbonds); 11
  Hydrogen Bond Donor Count (hbonddonor); 0
  Hydrogen Bond Acceptor Count (hbondacc); 4
• ADMET Property:
  Clearance: The clearance of drug is 4.17 +/- 2.37 L/min [3]
  Elimination: Approximately 10% of an administered dose is excreted unchanged in the urine [4]
  Half-life: The concentration or amount of drug in body reduced by one-half in 47 seconds [5]
  Metabolism: The drug is metabolized via plasma cholinesterase in the bloodstream to succinylmonocholine [4]
  Vd: The volume of distribution (Vd) of drug is 0.0164 L/kg [6]
• Chemical Identifiers:
  Formula: C14H30N2O4+2
  IUPAC Name: trimethyl-[2-[4-oxo-4-[2-(trimethylazaniumyl)ethoxy]butanoyl]oxyethyl]azanium
  Canonical SMILES: C[N+](C)(C)CCOC(=O)CCC(=O)OCC[N+](C)(C)C
  InChI: InChI=1S/C14H30N2O4/c1-15(2,3)9-11-19-13(17)7-8-14(18)20-12-10-16(4,5)6/h7-12H2,1-6H3/q+2
  InChIKey: AXOIZCJOOAYSMI-UHFFFAOYSA-N
• Cross-matching ID:
  PubChem CID: 5314
  ChEBI ID: CHEBI:45652
  CAS Number: 306-40-1
  DrugBank ID: DB00202
  TTD ID: D0Q7ZQ
• Repurposed Drugs (RPD): Click to Jump to the Detailed RPD Information of This Drug

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Muscarinic acetylcholine receptor M3 (CHRM3)	TTQ13Z5	ACM3_HUMAN	Antagonist	[7]

Drug Off-Target (DOT)

DOT Name	DOT ID	UniProt ID	Interaction	REF
Cholinesterase (BCHE)	OTOH3WQ9	CHLE_HUMAN	Drug Response	[8]
Myoglobin (MB)	OTYWYL2D	MYG_HUMAN	Protein Interaction/Cellular Processes	[9]

Molecular Expression Atlas of This Drug

• The Studied Disease: Plasma cell myeloma
• ICD Disease Classification: 2A83.1

Molecule Name	Molecule Type	Gene Name	p-value	Fold-Change	Z-score
Muscarinic acetylcholine receptor M3 (CHRM3)	DTT	CHRM3	4.61E-07	-0.59	-0.73

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Disease Different from Succinylcholine (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Clindamycin	DM15HL8	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Clindamycin.	Acne vulgaris [ED80]	[10]
Magnesium Sulfate	DMVEK07	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Magnesium Sulfate.	Acute pain [MG31]	[11]
Framycetin	DMF8DNE	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Framycetin.	Alcoholic liver disease [DB94]	[12]
Tacrine	DM51FY6	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Tacrine.	Alzheimer disease [8A20]	[13]
Galantamine	DMEO794	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Galantamine.	Alzheimer disease [8A20]	[13]
Donepezil	DMIYG7Z	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Donepezil.	Alzheimer disease [8A20]	[13]
Paromomycin	DM1AGXN	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Paromomycin.	Amoebiasis [1A36]	[12]
Trimethaphan	DMHF4IQ	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Trimethaphan.	Aneurysm/dissection [BD50]	[14]
Terbutaline	DMD4381	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Terbutaline.	Asthma [CA23]	[14]
Spectinomycin	DM0MQ35	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Spectinomycin.	Bacterial infection [1A00-1C4Z]	[14]
Kanamycin	DM2DMPO	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Kanamycin.	Bacterial infection [1A00-1C4Z]	[12]
Amikacin	DM5PDRB	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Amikacin.	Bacterial infection [1A00-1C4Z]	[12]
Streptomycin	DME1LQN	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Streptomycin.	Bacterial infection [1A00-1C4Z]	[12]
Gentamicin	DMKINJO	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Gentamicin.	Bacterial infection [1A00-1C4Z]	[12]
Capreomycin	DMNZBRY	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Capreomycin.	Bacterial infection [1A00-1C4Z]	[15]
Oxytetracycline	DMOVH1M	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Oxytetracycline.	Bacterial infection [1A00-1C4Z]	[14]
Netilmicin	DMRD1QK	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Netilmicin.	Bacterial infection [1A00-1C4Z]	[12]
Tobramycin	DMUI0CH	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Tobramycin.	Bacterial infection [1A00-1C4Z]	[12]
Minocycline	DMVN5OH	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Minocycline.	Bacterial infection [1A00-1C4Z]	[14]
Tetracycline	DMZA017	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Tetracycline.	Bacterial infection [1A00-1C4Z]	[14]
Thiotepa	DMIZKOP	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Thiotepa.	Breast cancer [2C60-2C6Y]	[14]
Demeclocycline	DMZEPFJ	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Demeclocycline.	Bronchitis [CA20]	[14]
Sotalol	DML60TN	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Sotalol.	Cardiac arrhythmia [BC9Z]	[16]
Irinotecan	DMP6SC2	Minor	Antagonize the effect of Succinylcholine when combined with Irinotecan.	Colorectal cancer [2B91]	[17]
Procaine	DM4LSNE	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Procaine.	Corneal disease [9A76-9A78]	[14]
Propofol	DMB4OLE	Moderate	Increased risk of bradycardia by the combination of Succinylcholine and Propofol.	Corneal disease [9A76-9A78]	[15]
Lidocaine	DML4ZOT	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Lidocaine.	Corneal disease [9A76-9A78]	[18]
Alfentanil	DMVO0UB	Moderate	Additive hypotensive effects by the combination of Succinylcholine and Alfentanil.	Corneal disease [9A76-9A78]	[19]
Timolol	DM3NXRU	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Timolol.	Essential hypertension [BA00]	[16]
Nadolol	DMW6GVL	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Nadolol.	Essential hypertension [BA00]	[16]
Amphotericin B	DMTAJQE	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Amphotericin B.	Fungal infection [1F29-1F2F]	[20]
Carteolol	DMFMDOB	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Carteolol.	Glaucoma [9C61]	[16]
Metipranolol	DMJMVKI	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Metipranolol.	Glaucoma [9C61]	[21]
Levobetaxolol	DMSREPX	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Levobetaxolol.	Glaucoma [9C61]	[21]
Levobunolol	DMTNFCQ	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Levobunolol.	Glaucoma [9C61]	[21]
Lincomycin	DMVTHER	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Lincomycin.	Gram-positive bacterial infection [1B74-1F40]	[10]
Carvedilol	DMHTEAO	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Carvedilol.	Heart failure [BD10-BD1Z]	[16]
Acebutolol	DM0TI4U	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Acebutolol.	Hypertension [BA00-BA04]	[16]
Bisoprolol	DM3UZ95	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Bisoprolol.	Hypertension [BA00-BA04]	[16]
Penbutolol	DM4ES8F	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Penbutolol.	Hypertension [BA00-BA04]	[16]
Nebivolol	DM7F1PA	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Nebivolol.	Hypertension [BA00-BA04]	[16]
Pindolol	DMD2NV7	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Pindolol.	Hypertension [BA00-BA04]	[16]
Labetalol	DMK8U72	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Labetalol.	Hypertension [BA00-BA04]	[16]
Atenolol	DMNKG1Z	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Atenolol.	Hypertension [BA00-BA04]	[16]
Metoprolol	DMOJ0V6	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Metoprolol.	Hypertension [BA00-BA04]	[16]
Physostigmine	DM2N0TO	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Physostigmine.	Lips/oral mucosa miscellaneous disorder [DA02]	[13]
Thalidomide	DM70BU5	Moderate	Increased risk of ventricular arrhythmias by the combination of Succinylcholine and Thalidomide.	Multiple myeloma [2A83]	[22]
Siponimod	DM2R86O	Major	Increased risk of bradycardia by the combination of Succinylcholine and Siponimod.	Multiple sclerosis [8A40]	[22]
Fingolimod	DM5JVAN	Moderate	Increased risk of bradycardia by the combination of Succinylcholine and Fingolimod.	Multiple sclerosis [8A40]	[23]
Ozanimod	DMT6AM2	Moderate	Increased risk of bradycardia by the combination of Succinylcholine and Ozanimod.	Multiple sclerosis [8A40]	[24]
Neostigmine	DM6T2J3	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Neostigmine.	Myasthenia gravis [8C6Y]	[13]
Edrophonium	DMCRQHB	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Edrophonium.	Myasthenia gravis [8C6Y]	[13]
Metoclopramide	DMFA5MY	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Metoclopramide.	Nausea/vomiting [MD90]	[14]
Ranitidine	DM0GUSX	Minor	Antagonize the effect of Succinylcholine when combined with Ranitidine.	Peptic ulcer [DA61]	[25]
Doxycycline	DM7ICNU	Moderate	Additive neuromuscular blocking effects by the combination of Succinylcholine and Doxycycline.	Periodontal disease [DA0C]	[14]
Colistimethate	DMZ9BMU	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Colistimethate.	Respiratory infection [CA07-CA4Z]	[15]
Cyclophosphamide	DM4O2Z7	Moderate	Antagonize the effect of Succinylcholine when combined with Cyclophosphamide.	Solid tumour/cancer [2A00-2F9Z]	[26]
Plazomicin	DMKMBES	Major	Additive neuromuscular blocking effects by the combination of Succinylcholine and Plazomicin.	Urinary tract infection [GC08]	[12]

References

• [1] Succinylcholine FDA Label
• [2] URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Ligand id: 4004).
• [3] Kato M, Shiratori T, Yamamuro M, Haga S, Hoshi K, Matsukawa S, Jalal IM, Hashimoto Y: Comparison between in vivo and in vitro pharmacokinetics of succinylcholine in humans. J Anesth. 1999 Oct 30;13(4):189-92. doi: 10.1007/s005400050055.
• [4] Health Canada Product Monograph: Quelicin (succinylcholine chloride) for injection
• [5] Pharmacokinetics and pharmacodynamics of suxamethonium. Anaesth Intensive Care. 1997 Jun;25(3):272-8. doi: 10.1177/0310057X9702500312.
• [6] Hoshi K, Hashimoto Y, Matsukawa S: Pharmacokinetics of succinylcholine in man. Tohoku J Exp Med. 1993 Aug;170(4):245-50. doi: 10.1620/tjem.170.245.
• [7] The involvement of histaminic and muscarinic receptors in the bronchoconstriction induced by myorelaxant administration in sensitized rabbits. Anesth Analg. 2008 Dec;107(6):1899-906.
• [8] Response of the newborn to succinlycholine injection in homozygotic atypical mothers. Anesthesiology. 1975 Jul;43(1):115-6. doi: 10.1097/00000542-197507000-00028.
• [9] Midazolam pretreatment does not ameliorate myoglobinemia or the clinical side effects of succinylcholine. J Clin Anesth. 1993 Sep-Oct;5(5):414-8. doi: 10.1016/0952-8180(93)90107-p.
• [10] Alahdal O, Bevan DR "Clindamycin-induced neuromuscular blockade." Can J Anaesth 42 (1995): 614-7. [PMID: 7553999]
• [11] Fuchs-Buder T, Wilder-Smith OH, Borgeat A, Tassonyi E "Interaction of magnesium sulphate with vecuronium-induced neuromuscular block." Br J Anaesth 74 (1995): 405-9. [PMID: 7734259]
• [12] Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg 58 (1979): 107-15. [PMID: 571233]
• [13] Freeman SE, Dawson RM "Tacrine: a pharmacological review." Prog Neurobiol 36 (1991): 257-77. [PMID: 1714613]
• [14] Multum Information Services, Inc. Expert Review Panel.
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• [17] Product Information. Anectine (succinylcholine). Glaxo Wellcome, Research Triangle Park, NC.
• [18] Bruckner J, Thomas KC, Bikhazi GB, Foldes FF "Neuromuscular drug interactions of clinical importance." Anesth Analg 59 (1980): 678-82. [PMID: 7191227]
• [19] Product Information. Alfenta (alfentanil). Janssen Pharmaceutica, Titusville, NJ.
• [20] Cushard WG, Kohanim M, Lantis LR "Blastomycosis of bone." J Bone Joint Surg Am 51A (1969): 704-12. [PMID: 5819086]
• [21] Harrah MD, Way WL, Katzung BG "The interaction of d-tubocurarine with antiarrhythmic drugs." Anesthesiology 33 (1970): 406-10. [PMID: 5512329]
• [22] Cerner Multum, Inc. "Australian Product Information.".
• [23] Product Information. Gilenya (fingolimod). Novartis Pharmaceuticals, East Hanover, NJ.
• [24] Product Information. Zeposia (ozanimod). Celgene Corporation, Summit, NJ.
• [25] Katende RS, Dimich I "Resistance to nondepolarizing muscle relaxants in a patient treated with ranitidine." Mt Sinai J Med 54 (1987): 330-1. [PMID: 2955219]
• [26] Dillman JB "Safe use of succinylcholine during repeated anesthetics in a patient treated with cyclophosphamide." Anesth Analg 66 (1987): 351-3. [PMID: 3565800]