Pharmacogenetic testing for Suxamethonium (Succinylcholine)

posted May 30, 2017, 5:19 AM by Vinod Scaria   [ updated May 30, 2017, 5:19 AM ]

Suxamethonium (Succinylcholine) is an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Succinylcholine, is a fast-acting depolarising muscle relaxant and is widely used in clinical settings. Succinylcholine is an analog of the neurotransmitter acetylcholine. The molecule binds non-competitively and therefore the binding cannot be reversed and recovery is spontaneous.

The molecule is metabolised by the BChE enzyme encoded by the BCHE gene. Patients with normal BCHE gene hydrolyze 90% of the injected drug dose before it reaches nerve synapse in the muscle. In contrast, subjects with an abnormal BChE gene results in a huge overdose leading to prolonged muscle paralysis, a serious and potentially lethal adverse drug response. Apart from succinylcholine containing drugs Quelicin & Anectine, the gene also is involved in metabolism of mivacurium, ester local anesthetics particularly chloroprocaine. 

The prevalence of BCHE deficiency varies with population as well as ethnic subgroups. The incidence is approximately 1 in 100,000 individuals of European or American descent being homozygous for the variant, whereas some ethnic subgroups, including the Vysya community of India have a high prevalence of approximately 4%. 

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