Management of Lercanidipine Before Electroconvulsive Therapy (ECT)
Lercanidipine should not be administered only the night before ECT at a dose of 20 mg, as calcium channel blockers should be continued through the perioperative period to prevent cardiovascular complications.
Cardiovascular Medication Management Before ECT
- ECT causes significant cardiovascular stress that requires careful medication management, with premedication using agents like atropine or glycopyrrolate recommended to protect against vagally induced bradycardia or arrhythmia 1
- Antihypertensive medications, including calcium channel blockers like lercanidipine, should generally be continued through the perioperative period to maintain cardiovascular stability 1
- Abrupt discontinuation of antihypertensive medications before ECT may lead to rebound hypertension and increase the risk of cardiovascular complications during the procedure 1
Lercanidipine Pharmacology Relevant to ECT
- Lercanidipine is a highly lipophilic dihydropyridine calcium channel blocker with a slower onset but longer duration of action compared to other calcium channel antagonists 2, 3
- Despite its short plasma half-life, lercanidipine has a prolonged duration of action due to its high lipophilicity and membrane-controlled kinetics 4, 5
- At 20 mg dosing, lercanidipine provides significant blood pressure reduction with effects lasting up to 24 hours, making it suitable for once-daily dosing 3, 6
Pre-ECT Evaluation and Medication Management
- A comprehensive pre-ECT evaluation must include review of all current medications with special attention to those that may affect seizure threshold 7
- Calcium channel blockers like lercanidipine do not significantly affect seizure threshold and are generally safe to continue during ECT 7
- The American Academy of Child and Adolescent Psychiatry recommends that medications that do not interfere with ECT should be maintained on their regular schedule 1, 7
Specific Recommendations for Lercanidipine Management
- For patients on lercanidipine undergoing ECT, the medication should be administered on its regular schedule (typically once daily) including the morning of the procedure 2, 3
- Giving lercanidipine only the night before ECT at 20 mg (which is the maximum recommended dose) and then discontinuing it could lead to unstable blood pressure during and after the procedure 1, 3
- Monitoring of vital signs, including blood pressure, is essential during and after ECT, with resources available for management of hypertensive episodes 1
Common Pitfalls to Avoid
- Discontinuing antihypertensive medications before ECT can lead to rebound hypertension and hemodynamic instability during the procedure 1
- Administering higher than usual doses of antihypertensive medications immediately before ECT may cause excessive hypotension during anesthesia 1, 7
- Failure to communicate medication regimens between the psychiatrist, anesthesiologist, and other members of the ECT team may lead to medication errors and adverse outcomes 7