Evaluation of the chemical stability of succinylcholine chloride stored in syringes under room-temperature conditions

Abstract

Background: Succinylcholine chloride is essential for achieving neuromuscular blockade during emergency airway management. The manufacturer specifies a 14-day stability period for 20 mg/mL vials at room temperature, which limits implementation of prefilled-syringe protocols. Aim: This study aims to investigate the chemical stability of succinylcholine chloride after transfer from manufacturer vials to polypropylene syringes during extended room-temperature storage. Methods: A validated high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method was developed to quantify percent recovery. Ten 20 mg/mL succinylcholine chloride vials were used: five samples were stored refrigerated (2–8°C; controls; n = 5), and five were transferred to polypropylene syringes and stored at room temperature (20–25°C; n = 5). Samples were analyzed over 90 days. The HPLC-UV method met United States Pharmacopeia criteria for accuracy, precision (<5% error and % relative standard deviation), and linearity (R² > 0.99). Results: Succinylcholine chloride maintained >90% of the initial concentration over 90 days in polypropylene syringes stored at room temperature (93.13% on day 90) and in refrigerated controls (93.97% on day 90). No significant differences were observed between storage conditions (p >0.05). All samples remained physically stable, with no visible color change or precipitate. Conclusion: Despite its ester bonds, succinylcholine chloride remained chemically stable in polypropylene syringes for up to 90 days at room temperature. Relevance for Patients: These findings support the extended stability of prefilled succinylcholine syringes, which may improve emergency preparedness; however, sterility validation remains necessary before clinical implementation.

Keywords

Succinylcholine chloride / Neuromuscular blocking agents / Drug stability / High-performance liquid chromatography–ultraviolet detection / Prefilled syringes / Emergency medicine

Acknowledgments

The authors would like to acknowledge the provision of materials from Ballad Health.

Funding

This study was supported by the Bill Gatton College of Pharmacy, East Tennessee State University.

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Conceptualization: Timothy Coffey, Stacy Brown Data curation: Jeffrey Klein Formal analysis: Stacy Brown Funding acquisition: Stacy Brown Investigation: Jeffrey Klein Methodology: Stacy Brown, Jeffrey Klein Project administration: Timothy Coffey, Stacy Brown Software: Stacy Brown Resources: Timothy Coffey, Stacy Brown Supervision: Stacy Brown Validation: Stacy Brown, Jeffrey Klein Visualization: Timothy Coffey Writing-original draft: Stacy Brown, Jeffrey Klein Writing-review & editing: Stacy Brown

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data

Not applicable.

Further disclosure

The HPLC-UV method development and validation that supported this study were previously presented (prior to initiation of the stability study) as a poster at the Appalachian Student Research Forum (ASRF), April 5, 2024, Johnson City, Tennessee, United States, titled “Chemical Potency of Succinylcholine Chloride Stored in Room-Temperature Syringes.”

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