Notrixum Drug Interactions

The neuromuscular block produced by Atracurium besylate may be increased by the concomitant use of inhalation anaesthetics, e.g. halothane, isoflurane and enflurane.
In common with all nondepolarising neuromuscular-blocking agents, the magnitude and/or duration of a non depolarising neuromuscular block may be increased as a result of interaction with: Antibiotics, including the aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin and clindamycin.
Antiarrhythmic Drugs: propranolol, calcium-channel blockers, lignocaine, procainamide and quinidine.
Diuretics: Furosemide and possibly mannitol, thiazide diuretics and acetazolamide.
Magnesium sulfate.
Ketamine.
Lithium salts.
Ganglion-Blocking Agents: Trimetaphan, hexamethonium.
Rarely, certain drugs may aggravate or unmask latent myasthenia gravis or actually induce a myasthenic syndrome; increased sensitivity to Atracurium besylate would be consequent on such a development. Such drugs include various antibiotics, B-blockers (propranolol, oxprenolol), antiarrhythmic drugs (procainamide, quinidine), antirheumatic drugs (chloroquine, D-penicillamine), trimetaphan, chlorpromazine, steroids, phenytoin and lithium.
The onset of nondepolarising neuromuscular block is likely to be lengthened and the duration of block shortened in patients receiving chronic anticonvulsant therapy.
The administration of combination nondepolarising neuromuscular-blocking agents in conjunction with Atracurium besylate may produce a degree of neuromuscular blockade in excess of that which might be expected were an equipotent total dose of Atracurium besylate was administered. Any synergistic effect may vary between different drug combinations.
A depolarizing muscle relaxant, e.g. suxamethonium chloride should not be administered to prolong the neuromuscular blocking effects of nondepolarising agents, e.g. Atracurium besylate, as this may result in a prolonged and complex block which can be difficult to reverse with anticholinesterase drugs.