Drug Interactions between amikacin and cisatracurium

GENERALLY AVOID: Aminoglycosides possess neuromuscular blocking activity, which may be additive with that of depolarizing and nondepolarizing muscle relaxants, potentially resulting in severe and/or prolonged respiratory depression during concomitant use. Aminoglycosides inhibit the release of acetylcholine at neuromuscular junctions by interfering with calcium influx. They also appear to decrease the sensitivity of postsynaptic membrane to acetylcholine. The interaction has been observed with various routes of aminoglycoside administration including oral, intramuscular, intravenous, intraperitoneal, esophageal, intraluminal, intradural, and beneath skin flaps. Respiratory paralysis and fatalities have been reported. Patients at increased risk include those with renal impairment and/or hypocalcemia.

MANAGEMENT: The use of aminoglycosides should generally be avoided during and immediately after surgery in which neuromuscular blockers have been employed. If these agents are used concurrently, vital signs should be closely monitored and drug dosages adjusted accordingly. In addition, ventilatory support should be readily available in case of respiratory arrest. Treatment with anticholinesterases and calcium may not always be effective in reversing the neuromuscular blockade caused by these agents.