Cisatracurium Kabi Drug Interactions

Many medicinal products have been shown to influence the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents, including the following: Increased Effect: by anaesthetic medicinal products such as enflurane, isoflurane, halothane (see Dosage & Administration) and ketamine; by other non-depolarising neuromuscular blocking agents; by other medicinal products such as antibiotics (including the aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin and clindamycin); by antiarrhythmics (including propranolol, calcium channel blockers, lidocaine, procainamide and quinidine); by diuretics, (including furosemide and possibly thiazides, mannitol and acetazolamide); by magnesium and lithium salts; and by ganglion blocking agents (trimethaphan, hexamethonium).
Rarely, certain medicinal products may aggravate or unmask latent myasthenia gravis or actually induce a myasthenic syndrome; increased sensitivity to non-depolarising neuromuscular blocking agents might result. Such agents include various antibiotics, beta blockers (propranolol, oxprenolol), antiarrhythmics (procainamide, quinidine), antirheumatics (chloroquine, D-penicillamine), trimethaphan, chlorpromazine, steroids, phenytoin and lithium.
Administration of suxamethonium to prolong the effects of non-depolarising neuromuscular blocking agents may result in a prolonged and complex block which can be difficult to reverse with anticholinesterases.
Decreased effect: A decreased effect is seen after preceding chronic administration of phenytoin or carbamazepine.
Treatment with anticholinesterases, commonly used in the treatment of Alzheimer's disease e.g. donepezil, may shorten the duration and diminish the magnitude of neuromuscular blockade with cisatracurium.
No effect: Preceding administration of suxamethonium has no effect on the duration of neuromuscular block following bolus doses of cisatracurium or on infusion rate requirements.