Succinylcholine drug interactions during electroconvulsive therapy

Electroconvulsive therapy (ECT) is frequently described as being almost free of absolute contraindications. However, drug interactions with succinylcholine pose potential hazards to which this paper calls attention. In addition to its neuromuscular-blocking action, succinylcholine has other acetylcholine-like effects. Drugs which inhibit cholinesterase activity or which inhibit acetylcholine release or synthesis may produce prolonged respiratory paralysis when combined with succinylcholine. The increasing longevity of the population receiving chemotherapy for physical ailments implies that greater numbers of these patients may also become candidates for ECT and therefore be at risk for adverse drug interactions with succinylcholine. Of particular importance to the psychiatrist are the various psychotropic drugs that have been reported to interact with succinylcholine. Precautions in using drug combinations and treatment of complications are described.