Suxamethonium

Summary

Suxamethonium (CHEMBL703) is an approved small-molecule neuromuscular agent (ATC M03AB01) targeting CHRNA1; indicated across 3 conditions including stroke disorder.

At a glance

• Status: Approved (max clinical phase 4)
• Modality: Small molecule
• ATC class: M03AB01
• Targets: 1 (CHRNA1)
• Indications: 3 conditions
• Clinical trials: 28
• Chemistry: 290.4 Da · C14H30N2O4+2

Identifiers

Drug identity and classification

Field	Value
ChEMBL ID	CHEMBL703
Name	Suxamethonium
Type	Small molecule
Max phase	4
FDA approved	yes
PubChem CID	5314
ChEBI	CHEBI:45652
ATC	M03AB01
Molecular formula	C14H30N2O4+2
Molecular weight	290.4
InChIKey	AXOIZCJOOAYSMI-UHFFFAOYSA-N

SMILES: C[N+](C)(C)CCOC(=O)CCC(=O)OCC[N+](C)(C)C

IUPAC name: trimethyl-[2-[4-oxo-4-[2-(trimethylazaniumyl)ethoxy]butanoyl]oxyethyl]azanium

ChEBI definition: A quaternary ammonium ion that is the bis-choline ester of succinic acid.

Pharmacological roles (ChEBI): neuromuscular agent, muscle relaxant, drug allergen.

Also known as: Succinylcholine, Succinylcholine cation, Succinylcholine ion, Suxamethonium, Suxamethonium cation, Suxamethonium ion, SID90341285, SID11111825, succinylcholine, SUXAMETHONIUM, suxamethonium

Parent form; salt/anhydrous children: CHEMBL983, CHEMBL2104486, CHEMBL3391771

Patent coverage: 3,337 distinct patent families (8,527 SureChEMBL compound mentions), from 1 matched compound structure(s). Mentions count patents naming the compound (not distinct inventions), so promiscuous / reference molecules inflate the mention figure — families are the dedup metric.

Targets

Targets

Primary targets (GtoPdb curated mechanism): the Cancer dependency column is the DepMap CRISPR fitness signal (% of screened cell lines dependent on the target).

Gene	Target	Action	pAffinity	Cancer dependency	UniProt
CHRNA1	nicotinic acetylcholine receptor α1 subunit	Full agonist		0%	P02708

Broader ChEMBL bioactivity targets: 3 (assay-derived). Sample: Alpha-2A adrenergic receptor, Alpha-1A adrenergic receptor, Acetylcholinesterase.

Bioactivity

ChEMBL activities: 1 potent at pChembl ≥ 5 of 3 total. Top 100 by potency (10 = 0.1 nM, 6 = 1 µM):

Target	pChembl	Type	Value	Unit	Activity ID
ADRA1A	6.18	AC50	667.4	nM	CHEMBL_ACT_25208288

Target pathways

Aggregated over 1 target gene(s): CHRNA1.

Top Reactome pathways

8 total, by targets touching each:

Pathway	Targets	Genes
Neurotransmitter receptors and postsynaptic signal transmission	1	CHRNA1
Transmission across Chemical Synapses	1	CHRNA1
Neuronal System	1	CHRNA1
Acetylcholine binding and downstream events	1	CHRNA1
Presynaptic nicotinic acetylcholine receptors	1	CHRNA1
Postsynaptic nicotinic acetylcholine receptors	1	CHRNA1
Highly calcium permeable postsynaptic nicotinic acetylcholine receptors	1	CHRNA1
Highly calcium permeable nicotinic acetylcholine receptors	1	CHRNA1

Dominant GO biological processes

GO term	Targets
skeletal muscle contraction	1
synaptic transmission, cholinergic	1
neuromuscular synaptic transmission	1
neuromuscular junction development	1
neuronal action potential	1
monoatomic ion transmembrane transport	1
response to nicotine	1
regulation of membrane potential	1
muscle cell cellular homeostasis	1
skeletal muscle tissue growth	1
musculoskeletal movement	1
neuromuscular process	1
membrane depolarization	1
neuron cellular homeostasis	1
acetylcholine receptor signaling pathway	1

Indications & clinical

Indications

1 disease in clinical trials (phase 1–3, investigational — not approved indications). Highest ChEMBL trial phase per disease; a non-cancer approved use is occasionally logged at phase 3 here.

Disease (in trials)	Phase	MONDO	EFO
stroke disorder	3	MONDO:0005098	EFO:0000712

2 further indication records had no mapped disease name (EFO/MeSH-only) or were duplicates, and are omitted.

Clinical trials

Total trials: 28.

Phase distribution

Phase	Trials
PHASE4	13
Not specified	10
PHASE3	4
PHASE2	1

Top trials by phase / activity

NCT	Phase	Status	Title
NCT00355368	PHASE4	COMPLETED	Succinylcholine Versus Rocuronium for Emergency Intubation in Intensive Care
NCT00815048	PHASE4	COMPLETED	Remifentanil and Atropine for Intubation in Neonates
NCT00953550	PHASE4	COMPLETED	Rapid Sequence Intubation With Rocuronium-Sugammadex Compared With Succinylcholine
NCT01579864	PHASE4	TERMINATED	Succinylcholine or Rocuronium for Rigid Bronchoscopy Under General Anesthesia
NCT01718236	PHASE4	COMPLETED	Modern Myorelaxation Procedure and Reversal of Neuromuscular Blockade With General Anesthesia for Caesarean Section
NCT01907217	PHASE4	COMPLETED	Enhancing the Effectiveness of Electroconvulsive Therapy in Severe Depression
NCT01941628	PHASE4	COMPLETED	Comparison of Surgical Conditions in Cesarean Section Under General Anesthesia With Deep Neuromuscular Blockade Versus Succinylcholine
NCT02237443	PHASE4	COMPLETED	Mask Ventilation Before and After Neuromuscular Blockade
NCT02410590	PHASE4	WITHDRAWN	Rocuronium + Sugammadex vs. Succinylcholine + Cisatracurium + Neostigmine/Atropine in Obese Participants (MK-8616-104)
NCT02425449	PHASE4	COMPLETED	Fade Upon TOF Stimulation Induced by Succinylcholine
NCT02635542	PHASE4	COMPLETED	Effect of Neuromuscular Blockade on Pulmonary Complications in Elective Cardiac Surgery
NCT04868409	PHASE4	COMPLETED	Intubating Conditions During Rapid Sequence Induction in Elderly With Either Suxamethonium 1.0 mg/kg or Rocuronium 1.0 mg/kg
NCT05556408	PHASE4	COMPLETED	High-Resolution Solid-State Manometry of the Effect of Succinylcholine on Barrier Pressure
NCT00474253	PHASE3	COMPLETED	Comparison of Recovery From Rocuronium 1.2 mg/kg Followed by Sugammadex (Org 25969) 16 mg/kg at 3 Minutes With Recovery From Succinylcholine 1.0 mg/kg (19.4.303)(P05946)(MK-8616-026)
NCT00751179	PHASE3	COMPLETED	Rocuronium Plus Sugammadex Versus Succinylcholine Alone in Participants Undergoing Short Surgical Procedures (19.4.319)(P05700 AM2)(COMPLETED)
NCT02822144	PHASE3	COMPLETED	General Anesthesia Versus Sedation During Intra-arterial Treatment for Stroke
NCT04581395	PHASE3	COMPLETED	The Effect of Pretreatment With Roc on Succinylcholine Myalgias
NCT01571908	PHASE2	COMPLETED	Rapid Sequence Intubation With Magnesium-rocuronium Compared With Succinylcholine - A Randomised Clinical Study
NCT06709066	Not specified	NOT_YET_RECRUITING	Muscle Relaxant Effect and Safety of Mivacurium Chloride and Succinylcholine for Bronchoscopy
NCT00462644	Not specified	COMPLETED	Evaluation of Etomidate on Adrenal Function in Trauma Patients
NCT00986583	Not specified	COMPLETED	Effect of Succinylcholine on Patients Using Statins
NCT01441960	Not specified	COMPLETED	Optimal Dose of Succinylcholine and Rocuronium for Electroconvulsive Therapy (ECT)
NCT01902641	Not specified	COMPLETED	Muscle Relaxation for Short Procedures
NCT01966484	Not specified	COMPLETED	Low Dose Mivacurium vs. Low Dose Succinylcholine for Rigid Bronchoscopy
NCT01996358	Not specified	SUSPENDED	Comparing Intubating Conditions Using Succinylcholine or Rocuronium for Rigid Bronchoscopy
NCT02667353	Not specified	COMPLETED	Neurorestorative Effects of Electroconvulsive Therapy (ECT) in Patients With Severe Late Life Depression
NCT02914119	Not specified	COMPLETED	Use of Neuromuscular Blocking Agents and Neuromuscular Monitoring in 7 Danish Teaching Hospitals
NCT03469323	Not specified	UNKNOWN	Effects of Succinylcholine on Nonintubated Thoracoscopic Surgery

Clinical evidence (CIViC)

No CIViC predictive evidence (expected for non-precision-medicine drugs).

Pharmacology

Pharmacogenomics

PharmGKB dosing guidelines (1) — CPIC / DPWG genotype-guided dosing for this drug (drug × pharmacogene):

Guideline	Source	Gene(s)	Dosing	Recommendation
Annotation of CPIC Guideline for desflurane, enflurane, halothane, iso	CPIC	CACNA1S;RYR1		yes

PharmGKB also curates 59 clinical and 99 variant annotation(s) for this drug (gene-keyed; see PharmGKB).

Related molecules

Related molecules

Molecules sharing ≥1 of this drug’s curated primary targets, merged from two biobtree sources and ranked by shared-target count, then clinical phase: ChEMBL clinical-stage candidates (development phase ≥2) and PubChem drug-class bioactivity (approved / known drugs acting on the target). Deduplicated by drug name; the drug’s own salt forms are excluded. Note: for a drug with few primary targets a shared-target match can reflect off-target / promiscuous binding rather than the same therapeutic mechanism — the phase ordering surfaces bona-fide therapeutics first.

14 molecules share ≥1 primary target. Top 14 by shared-target count:

Molecule	Source	Status	Shared targets
BUPROPION	ChEMBL + PubChem	Phase 4 (approved)	CHRNA1
MECAMYLAMINE	ChEMBL + PubChem	Phase 4 (approved)	CHRNA1
NICOTINE	ChEMBL + PubChem	Phase 4 (approved)	CHRNA1
VARENICLINE	ChEMBL + PubChem	Phase 4 (approved)	CHRNA1
TROPISETRON	ChEMBL	Phase 4 (approved)	CHRNA1
CYTISINICLINE	ChEMBL + PubChem	Phase 3 (approved)	CHRNA1
DEXMECAMYLAMINE	ChEMBL	Phase 3	CHRNA1
ALTINICLINE	ChEMBL	Phase 2	CHRNA1
GTS-21	ChEMBL	Phase 2	CHRNA1
MOLIBRESIB	ChEMBL	Phase 2	CHRNA1
RADAFAXINE	ChEMBL	Phase 2	CHRNA1
Atracurium	PubChem	Approved	CHRNA1
Imidacloprid	PubChem	Approved	CHRNA1
Ondansetron	PubChem	Approved	CHRNA1