Suxamethonium Cyclophosphamide

Drugs, such as suxamethonium hallucinogens, thiopentone, nemoleptics, amphetamines, apomorphine, and cyclophosphamide, have been used for torture, interrogation, and judicial execution.153 These drugs have been used to hurt, frighten, and confuse the victim to reveal the truth in case of murder or theft. 

Nitrogen mustard and related alkylating agents, such as cyclophosphamide, chlorambucil, triethylmelamine, and thiophosphoramide, prolong the action of suxamethonium (282,283). Plasma cholinesterase activity is reduced, possibly by alkylation of the enzyme. It has been suggested that azathioprine may potentiate suxamethonium by inhibition of phosphodiesterase activity (SEDA-4, 87) (284). 

Respiratory insufficiency and prolonged apnoea occurred in a patient on two occasions while receiving cyclophosphamide and undergoing anaesthesia during which suxamethonium (succinylcholine) and tubocurarine were used. Plasma cholinesterase levels were found to be low. Anaesthesia without the suxamethonium was uneventful. Seven out of 8 patients subsequently examined also showed depressed plasma cholinesterase levels while taking cyclophosphamide. ... 

Cyclophosphamide inhibits the aetivity of plasma cholinesterase, and as a result the metabolism of the suxamethonium is reduced and its actions are enhaneed and prolonged. Other alkylating agents are also reported to reduee plasma eholinesterase aetivity. ... 

---