Anaesthetics, general + SSRIs - Drug Interactions

Clinical evidence,mechanism, importance and management

A generalised tonic-clonic seizure occurred in a 42-year-old woman immediately after she was anaesthetised with 120mg of intravenous methohexital for last in a series of six electroconvulsive therapies. She had been receiving paroxetine 40mg daily throughout series

Two women in their mid-twenties,who had been taking fluoxetine 20mg daily for 4 to 6 months, had pronounced involuntary upper limb movements lasting 20 to 30 seconds immediately after anaesthetic induction with 180mg of propofol (2 to 2.5 mg/kg). The movements ceased spontaneously and rest of anaesthesia and surgery were uneventful. Neither had any history of epilepsy or movement disorders. It is not clear whether this was an interaction between propofol and fluoxetine or just a rare (but previously reported) reaction to propofol (See reference number 2).

Folkerts H. Spontaneous seizure after concurrent use of methohexital anesthesia for electroconvulsive therapy and paroxetine: a case report. J Nerv Ment Dis (1995) 183,115–16.

Armstrong TSH,Martin PD. Propofol, fluoxetine and spontaneous movement. Anaesthesia (1997) 52, 809–10.