Drug General Information (ID: DDI7HLXSGK)
Drug Name			Polymyxin B		Drug Info		Tubocurarine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antibiotics				Neuromuscular Blocking Agents
Structure

Mechanism of Polymyxin B-Tubocurarine Interaction (Severity Level: Major)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Drug Name		Polymyxin B				Tubocurarine
Mechanism		Neuromuscular blocking effects				Neuromuscular blocking agent Neuronal acetylcholine receptor  Antagonist
Key Mechanism Factor 1
		Factor Name		Neuronal acetylcholine receptor				Structure Sequence
		Protein Family		Ligand-gated ion channel (TC 1.A.9) family
		Protein Function		After binding acetylcholine, the AChR responds by an extensive change in conformation that affects all subunits and leads to opening of an ion-conducting channel across the plasma membrane.     Click to Show/Hide
Mechanism Description		Additive neuromuscular blocking effects by the combination of Polymyxin B and Tubocurarine

Recommended Action
Management		This combination should be avoided unless the benefit outweighs the risk. Patients should be closely monitored for signs of extended neuromuscular blockade.

References
1	Fogdall RP, Miller RD "Prolongation of a pancuronium-induced neuromuscular blockade by polymyxin B." Anesthesiology 40 (1974): 84-7. [PMID: 4359101]
2	Levine RA, Beiber MP, Forte FA, et al "Polymyxin B-induced respiratory paralysis reversed by intravenous calcium chloride." J Mt Sinai Hosp N Y 36 (1969): 380-7. [PMID: 4310774]
3	Product Information. Raplon (rapacuronium) Organon, West Orange, NJ.