Details of Drug Interaction | MecDDI

Drug General Information (ID: DDI21N3ACO)
Drug Name			Tobramycin		Drug Info		Neostigmine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antibiotics				Parasympathomimetics
Structure

Mechanism of Tobramycin-Neostigmine Interaction (Severity Level: Moderate)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph

Drug Name		Tobramycin				Neostigmine
Mechanism		Neuromuscular blocking effects Aminoglycosides				Neuromuscular blocking effects Acetylcholinesterase Inhibitor
Key Mechanism Factor 1
		Factor Name		Acetylcholinesterase				× Structure Sequence MRPPQCLLHTPSLASPLLLLLLWLLGGGVGAEGREDAELLVTVRGGRLRGIRLKTPGGPVSAFLGIPFAEPPMGPRRFLPPEPKQPWSGVVDATTFQSVCYQYVDTLYPGFEGTEMWNPNRELSEDCLYLNVWTPYPRPTSPTPVLVWIYGGGFYSGASSLDVYDGRFLVQAERTVLVSMNYRVGAFGFLALPGSREAPGNVGLLDQRLALQWVQENVAAFGGDPTSVTLFGESAGAASVGMHLLSPPSRGLFHRAVLQSGAPNGPWATVGMGEARRRATQLAHLVGCPPGGTGGNDTELVACLRTRPAQVLVNHEWHVLPQESVFRFSFVPVVDGDFLSDTPEALINAGDFHGLQVLVGVVKDEGSYFLVYGAPGFSKDNESLISRAEFLAGVRVGVPQVSDLAAEAVVLHYTDWLHPEDPARLREALSDVVGDHNVVCPVAQLAGRLAAQGARVYAYVFEHRASTLSWPLWMGVPHGYEIEFIFGIPLDPSRNYTAEEKIFAQRLMRYWANFARTGDPNEPRDPKAPQWPPYTAGAQQYVSLDLRPLEVRRGLRAQACAFWNRFLPKLLSATDTLDEAERQWKAEFHRWSSYMVHWKNQFDHYSKQDRCSDL
		Gene Name		ACHE
		Uniprot ID		ACES_HUMAN
		KEGG Pathway		hsa:43
		Protein Family		Type-B carboxylesterase/lipase family
		Protein Function		Hydrolyzes rapidly the acetylcholine neurotransmitter released into the synaptic cleft allowing to terminate the signal transduction at the neuromuscular junction. Role in neuronal apoptosis. Click to Show/Hide
Mechanism Description		Additive neuromuscular blocking effects by the combination of Tobramycin and Neostigmine

Recommended Action
Management		Caution and close monitoring for the efficacy of the anticholinesterase agent is recommended if it is to be used concomitantly with aminoglycosides, particularly in patients with myasthenia gravis. Concomitant use in these patients should be avoided if possible. If coadministration is considered necessary, the dose of the anticholinesterase agent may need to be increased.

References
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15	Product Information. Arikayce (amikacin liposome). Insmed Incorporated, Bridgewater, NJ.
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