Drug Interactions between Cleocin Phosphate and rapacuronium

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.