Drug General Information (ID: DDI9801ESL)
Drug Name			Vancomycin		Drug Info		Metocurine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinfective Agents				Neuromuscular Blocking Agents
Structure

Mechanism of Vancomycin-Metocurine Interaction (Severity Level: Moderate)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Drug Name		Vancomycin				Metocurine
Mechanism		Neuromuscular blocking effects Hypokalemia				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 Vancomycin and Metocurine

Recommended Action
Management		Patients should be monitored for excessive and prolonged neuromuscular blockade.

References
1	Huang KC, Heise A, Shrader AK, Tsueda K "Vancomycin enhances the neuromuscular blockade of vecuronium." Anesth Analg 71 (1990): 194-6. [PMID: 1973882]
2	Kronenfeld MA, Thomas SJ, Turndorf H "Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation." Anesthesiology 65 (1986): 93-4. [PMID: 2873764]