Cocaine and succinylcholine sensitivity: a new caution.
Cocaine was stable (93.6 +/- 5.0 (SD)% remaining after 120 minutes) when incubated in plasma from six patients with histories of succinylcholine sensitivity and low dibucaine numbers (phenotype A), but was rapidly hydrolyzed (40.6 +/- 6.6% remaining after 120 minutes) when incubated in plasma obtained from normal subjects (phenotype U). Intermediate decay (69.4 +/- 9.0% remaining) occurred in three heterozygous offspring of the succinylcholine-sensitive patients. Since serum cholinesterase has recently been implicated in the human metabolism of cocaine, patients who are homozygous for the atypical enzyme may be at greater risk for a toxic reaction when administered this drug. We recommend caution in using cocaine for topical anesthesia in patients with histories of succinylcholine sensitivity or low dibucaine numbers.
D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced; D002802:Cholinesterases / Q000097:blood; D003042:Cocaine / Q000009:adverse effects* / Q000097:blood; D003992:Dibucaine; D004342:Drug Hypersensitivity / Q000209:etiology; D006720:Homozygote; D006801:Humans; D006868:Hydrolysis; D010641:Phenotype; D013390:Succinylcholine / Q000009:adverse effects*
D002802:Cholinesterases; D003042:Cocaine; D013390:Succinylcholine; D003992:Dibucaine