title: Evaluating degradation with fragment formation of prehospital succinylcholine by mass spectrometry.
abstract: OBJECTIVE
  Pharmaceutical manufacturers recommend refrigerating succinylcholine at a temperature range of 2-8 degrees C. With widespread use of prehospital succinylcholine on ambulances without refrigeration, it is important to understand the stability of this drug. Using mass spectrometry, this study investigated the degradation of the succinylcholine compound before and after its exposure to ambulance cabin temperatures, while removing light exposure. A 10% degradation threshold was set as not appropriate for human use, in accordance with U.S. Food and Drug Administration guidelines.
  
  
  METHODS
  The study used 17 vials of succinylcholine sealed with duct tape in light-resistant bags. The bags were placed in climate controlled compartments in two ambulances: one stationed in a garage and the other stationed outdoors. Mass spectrometry analysis was used to examine drug degradation at Time 0, the 14th day of the first month, and monthly from Time 0 to 7 months.
  
  
  RESULTS
  The degradation products of succinyl monocholine (SMC) and choline are already present at Day 0. Ten percent degradation was achieved at approximately 90 days into the experiment. Temperature in the ambulance climate controlled compartment was 70 degrees F, with a range from 56 to 89 degrees F during the 6-month time period.
  
  
  CONCLUSIONS
  Identifiable breakdown fragments of succinylcholine have been identified using mass spectrometry with fresh drug upon receipt from the manufacturer. Ten percent degradation was not observed until approximately 90 days after being placed on ambulances. Temperature variations did not significantly contribute to degradation of succinylcholine, and it is safe for injection until approximately 90 days in similar climates.
authors.affiliation: Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. merlinma@umdnj.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Merlin
authors.forename: Andreia
authors.initials: A
authors.lastname: Marques-Baptista
authors.forename: Hilly
authors.initials: H
authors.lastname: Yang
authors.forename: Pamela
authors.initials: P
authors.lastname: Ohman-Strickland
authors.forename: Christopher
authors.initials: C
authors.lastname: Aquina
authors.forename: Brian
authors.initials: B
authors.lastname: Buckley
mesh_terms: D004355:Drug Stability; D004356:Drug Storage; D004632:Emergency Medical Services; D004780:Environment, Controlled; D006801:Humans; D013058:Mass Spectrometry; D009467:Neuromuscular Depolarizing Agents / Q000737:chemistry*; D011446:Prospective Studies; D013390:Succinylcholine / Q000737:chemistry*; D013696:Temperature
chemical_list: D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine