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Drug Interactions between kanamycin and pyridostigmine

This report displays the potential drug interactions for the following 2 drugs:

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Moderate

kanamycin pyRIDostigmine

Applies to: kanamycin and pyridostigmine

MONITOR: Aminoglycosides may antagonize the effects of anticholinesterase agents such as neostigmine and pyridostigmine. The interaction has been established between aminoglycosides and depolarizing and nondepolarizing muscle relaxants and is also predicted to occur with anticholinesterase agents. Anticholinesterase agents inhibit cholinesterase activity and lead to prolonged and intensified muscarinic and nicotinic effects of acetylcholine. Aminoglycosides appear to decrease the sensitivity of postsynaptic membrane to acetylcholine. They also possess neuromuscular blocking activity, which may interfere with neuromuscular transmission by inhibiting the release of acetylcholine at neuromuscular junctions by interfering with calcium influx. This effect on neuromuscular transmission may be particularly significant in patients with myasthenia gravis.

MANAGEMENT: Caution and close monitoring for the efficacy of the anticholinesterase agent is recommended if it is to be used concomitantly with aminoglycosides, particularly in patients with myasthenia gravis. Concomitant use in these patients should be avoided if possible. If coadministration is considered necessary, the dose of the anticholinesterase agent may need to be increased.

References

  1. Kronenfeld MA, Thomas SJ, Turndorf H (1986) "Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation." Anesthesiology, 65, p. 93-4
  2. Lippmann M, Yang E, Au E, Lee C (1982) "Neuromuscular blocking effects of tobramycin, gentamicin, and cefazolin." Anesth Analg, 61, p. 767-70
  3. Dupuis JY, Martin R, Tetrault JP (1989) "Atracurium and vecuronium interaction with gentamicin and tobramycin." Can J Anaesth, 36, p. 407-11
  4. Pittinger CB, Eryasa Y, Adamson R (1970) "Antibiotic-induced paralysis." Anesth Analg, 49, p. 487-501
  5. Giala MM, Paradelis AG (1979) "Two cases of prolonged respiratory depression due to interaction of pancuronium with colistin and streptomycin." J Antimicrob Chemother, 5, p. 234-5
  6. Warner WA, Sanders E (1971) "Neuromuscular blockade associated with gentamicin therapy." JAMA, 215, p. 1153-4
  7. Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF (1979) "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg, 58, p. 107-15
  8. Chapple DJ, Clark JL, Hughes R (1983) "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth, 55 Suppl, s17-22
  9. (2001) "Product Information. Humatin (paromomycin)." Parke-Davis
  10. Giala M, Sareyiannis C, Cortsaris N, Paradelis A, Lappas DG (1982) "Possible interaction of pancuronium and tubocurarine with oral neomycin." Anaesthesia, 37, p. 776
  11. Jedeikin R, Dolgunski E, Kaplan R, Hoffman S (1987) "Prolongation of neuromuscular blocking effect of vecuronium by antibiotics." Anaesthesia, 42, p. 858-60
  12. Regan AG, Perumbetti PP (1980) "Pancuronium and gentamicin interaction in patients with renal failure." Anesth Analg, 59, p. 393
  13. Vanacker BF, Van de Walle J (1986) "The neuromuscular blocking action of vecuronium in normal patients and in patients with no renal function and interaction vecuronium- tobramycin in renal transplant patients." Acta Anaesthesiol Belg, 37, p. 95-9
  14. Geha DG, Blitt CD, Moon BJ (1976) "Prolonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report." Anesth Analg, 55, p. 343-5
  15. Hasfurther DL, Bailey PL (1996) "Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin." Can J Anaesth, 43, p. 617-20
  16. Levanen J, Nordman R (1975) "Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride." Ann Clin Res, 7, p. 47-9
  17. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  18. Cerner Multum, Inc. "Australian Product Information."
  19. (2018) "Product Information. Arikayce (amikacin liposome)." Insmed Incorporated
View all 19 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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