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Drug Interactions between PMB and succinylcholine

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

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Interactions between your drugs

Moderate

succinylcholine conjugated estrogens

Applies to: succinylcholine and PMB (conjugated estrogens / meprobamate)

MONITOR: The neuromuscular blocking effect of succinylcholine may be potentiated by chronic administration of estrogens or high-dose corticosteroids. Available data suggest that steroids may reduce plasma cholinesterase activity, resulting in decreased metabolic clearance of succinylcholine. There have been isolated case reports of patients treated with estrogen-containing products such as estradiol and diethylstilbestrol who experienced prolonged apnea or muscle paralysis following succinylcholine administration. Laboratory testing demonstrated reduced serum pseudocholinesterase activity in these patients. One study conducted in 33 women of childbearing age reported significantly reduced serum cholinesterase levels after one month of treatment with various oral contraceptives, with no further reductions after three months. Another 33 women in the same study who had been taking oral contraceptives for at least one year exhibited similarly reduced levels of serum cholinesterase.

MANAGEMENT: Patients receiving chronic therapy with estrogens or corticosteroids should be monitored for increased or prolonged neuromuscular blockade when succinylcholine is administered. A lower initial dosage of succinylcholine may be required.

References (4)
  1. (2022) "Product Information. Quelicin Chloride (succinylcholine)." Hospira Inc
  2. (2022) "Product Information. Anectine (succinylcholine)." Sandoz Inc
  3. (2022) "Product Information. Suxamethonium Chloride (suxamethonium)." Advanz Pharma
  4. (2021) "Product Information. Suxamethonium (Accord) (suxamethonium)." Accord Healthcare Pty Ltd, 1.0

Drug and food interactions

Moderate

meprobamate food

Applies to: PMB (conjugated estrogens / meprobamate)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
Minor

conjugated estrogens food

Applies to: PMB (conjugated estrogens / meprobamate)

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.

References (2)
  1. Weber A, Jager R, Borner A, et al. (1996) "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception, 53, p. 41-7
  2. Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T (1995) "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet, 20, p. 219-24

Therapeutic duplication warnings

No warnings were found for your selected drugs.

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.

Further information

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