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Tubocurarine Disease Interactions

There are 8 disease interactions with tubocurarine:

Major

MDVs (applies to tubocurarine) prematurity

Major Potential Hazard, Moderate plausibility. Applicable conditions: Prematurity/Underweight in Infancy

Parenteral medications formulated in multidose vials often contain benzyl alcohol as a preservative. Their use is considered by drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. When used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, benzyl alcohol has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. Thus, single-dose formulations should always be used in infants whenever possible. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. However, the administration of high dosages of these medications must take into account the total amount of benzyl alcohol administered. The level at which toxicity may occur is unknown.

References

  1. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
  2. "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn, Kalamazoo, MI.
  3. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  4. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Mesnex (mesna)." Bristol-Myers Squibb, Princeton, NJ.
View all 6 references
Major

Neuromuscular blocking agents (applies to tubocurarine) electrolyte imbalance

Major Potential Hazard, High plausibility. Applicable conditions: Hypokalemia

Severe acid-base and/or electrolyte abnormalities may potentiate or cause resistance to the neuromuscular blocking action neuromuscular blocking agents. The potency of these agents may be mixed in metabolic acidosis and alkalosis, and in respiratory alkalosis. Since electrolyte imbalance and acid-base imbalance are usually mixed, either enhancement or inhibition may occur. Caution should be taken when using these agents in predisposed patients.

References

  1. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
  2. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
Major

Neuromuscular blocking agents (applies to tubocurarine) histamine release

Major Potential Hazard, High plausibility. Applicable conditions: Allergies, Asthma, Cardiovascular Disease

Some neuromuscular blocking agents stimulate the release of histamine, which can cause wheezing, bronchospasm, increased bronchial secretions, hypotension, tachycardia, and circulatory collapse. Hypotension may also occur due to ganglionic blockade or as a complication of positive pressure respiration. Tubocurarine appears to be the most potent inducer of histamine, followed by metocurine (no longer commercially available in the U.S.) and succinylcholine. Other agents with varying but lesser degrees of histamine-releasing properties include atracurium, mivacurium, and pancuronium (at excessive dosages). Therapy with these neuromuscular blocking agents should be administered cautiously in patients with clinically significant cardiovascular disease and/or a history of asthma or severe allergic reactions. Certain agents may prolong the QTc interval, especially during general anesthesia in pediatric patients. The initial dosage and rate of administration may need to be reduced, and hemodynamic and respiratory status carefully monitored. Neuromuscular blocking agents that appear to have little or no histamine-inducing effects include cisatracurium, doxacurium, pipecuronium, rocuronium, and vecuronium.

References

  1. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Zemuron (rocuronium)." Organon, West Orange, NJ.
  4. "Product Information. Norcuron (vecuronium)." Organon, West Orange, NJ.
  5. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
  6. "Product Information. Anectine (succinylcholine)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
View all 7 references
Major

Neuromuscular blocking agents (applies to tubocurarine) liver disease

Major Potential Hazard, High plausibility.

Neuromuscular blocking agents undergo metabolism by the liver. Elimination and effects may be prolonged in patients with liver disease. Therapy with neuromuscular blocking agents should be administered cautiously in patients with liver disease.

References

  1. "Product Information. Norcuron (vecuronium)." Organon, West Orange, NJ.
  2. "Product Information. Zemuron (rocuronium)." Organon, West Orange, NJ.
  3. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
  4. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
View all 5 references
Major

Neuromuscular blocking agents (applies to tubocurarine) myasthenia gravis

Major Potential Hazard, High plausibility.

The use of neuromuscular blocking agents may cause prolonged respiratory paralysis. Therapy with neuromuscular blocking agents should be administered cautiously in patients with myasthenia gravis. Use of a peripheral nerve stimulator may be helpful in evaluating the level of neuromuscular blockade.

References

  1. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  4. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
View all 4 references
Major

Neuromuscular blocking agents (applies to tubocurarine) paresis

Major Potential Hazard, High plausibility. Applicable conditions: Paralytic Disorder

Patients with hemiparesis or paraparesis may require higher dosages of non-depolarizing neuromuscular blocking agents in the affected limbs. Neuromuscular monitoring should be performed on a non-paretic limb to avoid inaccurate dosing.

References

  1. "Product Information. Norcuron (vecuronium)." Organon, West Orange, NJ.
  2. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
  4. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Zemuron (rocuronium)." Organon, West Orange, NJ.
  6. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
View all 6 references
Major

Neuromuscular blocking agents (applies to tubocurarine) pulmonary impair

Major Potential Hazard, High plausibility. Applicable conditions: Pulmonary Impairment

Neuromuscular blocking agents can cause respiratory depression and paralysis. Therapy with neuromuscular blocking agents should be administered cautiously in patients with pulmonary impairment. Treatment of respiratory paralysis consists of positive-pressure artificial respiration with oxygen and maintenance of a patent airway until the recovery of normal respiration is assured.

References

  1. "Product Information. Norcuron (vecuronium)." Organon, West Orange, NJ.
  2. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
  3. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  4. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Anectine (succinylcholine)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Zemuron (rocuronium)." Organon, West Orange, NJ.
  7. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
View all 7 references
Moderate

Neuromuscular blocking agents (applies to tubocurarine) renal dysfunction

Moderate Potential Hazard, High plausibility.

Many of the non-depolarizing (competitive) neuromuscular blocking agents undergo significant elimination by the kidney. Their effects may, therefore, be prolonged in patients with renal dysfunction. Therapy with these neuromuscular blocking agents should be administered cautiously and initiated at reduced dosages in renally compromised patients, depending on the level of insufficiency. If possible, alternative agents should be considered. Atracurium, rocuronium and vecuronium do not depend on kidney function for clearance and are often the non-depolarizing muscle relaxants of choice in renal failure.

References

  1. "Product Information. Anectine (succinylcholine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Zemuron (rocuronium)." Organon, West Orange, NJ.
  4. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  5. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Metubine Iodide (metocurine)." Dista Products Company, Indianapolis, IN.
  7. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  8. "Product Information. Norcuron (vecuronium)." Organon, West Orange, NJ.
View all 8 references

Tubocurarine drug interactions

There are 141 drug interactions with tubocurarine

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.