Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for the Use of Potent Volatile Anesthetic Agents and Succinylcholine in the Context of RYR1 or CACNA1S Genotypes

Clin Pharmacol Ther. 2019 Jun;105(6):1338-1344. doi: 10.1002/cpt.1319. Epub 2019 Jan 24.


The identification in a patient of 1 of the 50 variants in the RYR1 or CACNA1S genes reviewed here should lead to a presumption of malignant hyperthermia susceptibility (MHS). MHS can lead to life-threatening reactions to potent volatile anesthetic agents or succinylcholine. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for the use of these agents in patients with these RYR1 or CACNA1S variants (updates at and

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Review

MeSH terms

  • Anesthetics, Inhalation / administration & dosage
  • Anesthetics, Inhalation / adverse effects*
  • Calcium Channels, L-Type / genetics*
  • Genotype
  • Humans
  • Malignant Hyperthermia / etiology
  • Malignant Hyperthermia / genetics
  • Neuromuscular Depolarizing Agents / administration & dosage
  • Pharmacogenetics / methods
  • Pharmacogenetics / standards*
  • Practice Guidelines as Topic / standards*
  • Ryanodine Receptor Calcium Release Channel / genetics*
  • Succinylcholine / administration & dosage
  • Succinylcholine / adverse effects*
  • Volatilization


  • Anesthetics, Inhalation
  • CACNA1S protein, human
  • Calcium Channels, L-Type
  • Neuromuscular Depolarizing Agents
  • RYR1 protein, human
  • Ryanodine Receptor Calcium Release Channel
  • Succinylcholine