Drug Interaction Report

MONITOR: Oximes used in organophosphorous poisoning such as pralidoxime or obidoxime may antagonize the neuromuscular blocking effects of succinylcholine and mivacurium. Oximes reactivate acetylcholinesterase that has been inactivated by phosphorylation due to exposure to an organophosphorous nerve agent or insecticide, and the reactivated acetylcholinesterase then hydrolyzes excess acetylcholine resulting from the exposure to help restore impaired cholinergic neural function. Since succinylcholine and mivacurium are metabolized by plasma cholinesterases, patients with organophosphorous poisoning who have been treated with an oxime may exhibit accelerated reversal of the neuromuscular blocking effects of these agents relative to those who have not received an oxime.

MANAGEMENT: Neuromuscular effects should be monitored when succinylcholine or mivacurium is coadministered with an oxime.