From the FDA Drug Label
Plasma cholinesterase activity may also be diminished by chronic administration of oral contraceptives, glucocorticoids, or certain monoamine oxidase inhibitors and by irreversible inhibitors of plasma cholinesterase The neuromuscular blocking effect of succinylcholine may be enhanced by drugs that reduce plasma cholinesterase activity (e.g., chronically administered oral contraceptives, glucocorticoids, or certain monoamine oxidase inhibitors)
Succinylcholine Interaction with Hormonal Contraceptives:
- The use of oral contraceptives may reduce plasma cholinesterase activity, which can enhance the neuromuscular blocking effect of succinylcholine.
- This interaction may lead to prolonged apnea or muscle paralysis.
- However, the label does not provide information on whether succinylcholine interferes with the effectiveness of hormonal contraceptives, only that oral contraceptives can affect the activity of the enzyme that breaks down succinylcholine 1.
From the Research
Succinylcholine does not interfere with hormonal contraceptives, and patients receiving this medication can be assured that their contraceptive protection remains intact. The mechanism of action of succinylcholine, a neuromuscular blocking agent, is entirely separate from hormonal contraception, as it works by causing temporary paralysis of skeletal muscles through depolarization of the muscle membrane at the neuromuscular junction 2. Unlike some antibiotics or anticonvulsants that can reduce contraceptive effectiveness by inducing liver enzymes, succinylcholine's metabolism pathway does not involve the hepatic enzymes responsible for metabolizing hormonal contraceptives 3, 4. Some key points to consider include:
- The risk of drug interaction with hormonal contraceptives should be anticipated, as it may lead to unplanned pregnancies 2
- Most interactions lead to a decrease in the effectiveness of hormonal contraceptives, but succinylcholine is not known to have this effect 2
- The official recommendations established by various health organizations have been taken into account, and there is no mention of succinylcholine as a drug that interacts with hormonal contraceptives 2, 5
- Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences, but succinylcholine is not a factor in this decision-making process 5
- Patients receiving succinylcholine for medical procedures can be assured that their contraceptive protection remains intact, and no additional contraceptive measures are needed following administration of this medication 2, 5.