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Drug Interactions between metocurine and Otimar

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

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Moderate

metocurine neomycin topical

Applies to: metocurine and Otimar (hydrocortisone / neomycin / polymyxin b otic)

MONITOR: 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: Topically applied aminoglycosides may be systemically absorbed, and significant absorption could occur in certain circumstances (e.g., application to burnt or broken skin; use of large quantities or on large areas for prolonged periods). Clinicians should be aware of the potential for interaction if neuromuscular blockers are used in patients who have been treated extensively with topical aminoglycosides. Vital signs should be closely monitored, and 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.

References

  1. Kronenfeld MA, Thomas SJ, Turndorf H "Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation." Anesthesiology 65 (1986): 93-4
  2. Lippmann M, Yang E, Au E, Lee C "Neuromuscular blocking effects of tobramycin, gentamicin, and cefazolin." Anesth Analg 61 (1982): 767-70
  3. Dupuis JY, Martin R, Tetrault JP "Atracurium and vecuronium interaction with gentamicin and tobramycin." Can J Anaesth 36 (1989): 407-11
  4. Pittinger CB, Eryasa Y, Adamson R "Antibiotic-induced paralysis." Anesth Analg 49 (1970): 487-501
  5. Giala MM, Paradelis AG "Two cases of prolonged respiratory depression due to interaction of pancuronium with colistin and streptomycin." J Antimicrob Chemother 5 (1979): 234-5
  6. Warner WA, Sanders E "Neuromuscular blockade associated with gentamicin therapy." JAMA 215 (1971): 1153-4
  7. Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg 58 (1979): 107-15
  8. Chapple DJ, Clark JL, Hughes R "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth 55 Suppl (1983): s17-22
  9. Giala M, Sareyiannis C, Cortsaris N, Paradelis A, Lappas DG "Possible interaction of pancuronium and tubocurarine with oral neomycin." Anaesthesia 37 (1982): 776
  10. Jedeikin R, Dolgunski E, Kaplan R, Hoffman S "Prolongation of neuromuscular blocking effect of vecuronium by antibiotics." Anaesthesia 42 (1987): 858-60
  11. Regan AG, Perumbetti PP "Pancuronium and gentamicin interaction in patients with renal failure." Anesth Analg 59 (1980): 393
  12. Vanacker BF, Van de Walle J "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 (1986): 95-9
  13. Geha DG, Blitt CD, Moon BJ "Prolonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report." Anesth Analg 55 (1976): 343-5
  14. Hasfurther DL, Bailey PL "Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin." Can J Anaesth 43 (1996): 617-20
  15. Levanen J, Nordman R "Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride." Ann Clin Res 7 (1975): 47-9
View all 15 references

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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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