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Drug Interactions between atracurium and clindamycin topical

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

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Moderate

atracurium clindamycin topical

Applies to: atracurium and clindamycin topical

MONITOR: Lincosamides (e.g., clindamycin, lincomycin) have demonstrated neuromuscular blocking activity in vitro and may augment the pharmacologic effects of neuromuscular blocking agents. Clinically, the interaction has been reported in isolated cases involving atracurium, pancuronium, pipecuronium, succinylcholine, and tubocurarine. In one case, respiratory insufficiency was induced by the use of lincomycin in a patient recovering from blockade with tubocurarine. In another case, a patient developed prolonged neuromuscular blockade due to an unintentional overdose of clindamycin (2400 mg instead of 600 mg intravenously) shortly after recovery from succinylcholine and tubocurarine. Theoretically, the interaction may also occur with topically administered clindamycin due to systemic absorption, although no cases have been reported.

MANAGEMENT: Patients receiving neuromuscular blockers in conjunction with lincosamide therapy should be monitored closely during and after anesthesia for development of respiratory depression, and life support should be readily available if needed. Anticholinesterases and calcium may not completely antagonize the neuromuscular blockade induced by lincosamides.

References

  1. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn PROD (2002):
  2. Boolj LH, Miller RD, Crul JF "Neostigmine and 4-aminopyridine antagonism of lincomycin-pancuronium neuromuscular blockade in man." Anesth Analg 57 (1978): 316-21
  3. Rubbo JT, Gergis SD, Sokoll MD "Comparative neuromuscular effects of lincomycin and clindamycin." Anesth Analg 56 (1977): 329-32
  4. Avery D, Finn R "Succinylcholine-prolonged apnea associated with clindamycin and abnormal liver function tests." Dis Nerv Syst 38 (1977): 473-5
  5. de Gouw NE, Crul JF, Vandermeersch E, Mulier JP, van Egmond J, Van Aken H "Interaction of antibiotics on pipecuronium-induced neuromuscular blockade." J Clin Anesth 5 (1993): 212-5
  6. Jedeikin R, Dolgunski E, Kaplan R, Hoffman S "Prolongation of neuromuscular blocking effect of vecuronium by antibiotics." Anaesthesia 42 (1987): 858-60
  7. Alahdal O, Bevan DR "Clindamycin-induced neuromuscular blockade." Can J Anaesth 42 (1995): 614-7
  8. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn PROD (2001):
  9. Fogdall RP, Miller RD "Antagonism of d-tubocurarine- and pancuronium-induced neuromuscular blockades by pyridostigmine in man." Anesthesiology 39 (1973): 504-9
  10. "Product Information. Clindesse (clindamycin topical)." Ther-Rx Corporation (2004):
  11. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  12. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  13. Cerner Multum, Inc. "Australian Product Information." O 0
View all 13 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

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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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