Drug General Information (ID: DDI9FQ7UCD)
Drug Name			Cisatracurium		Drug Info		Kanamycin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Neuromuscular Blocking Agents				Antibiotics
Structure

Mechanism of Cisatracurium-Kanamycin Interaction (Severity Level: Major)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Drug Name		Cisatracurium				Kanamycin
Mechanism		Neuromuscular blocking agent Neuronal acetylcholine receptor  Antagonist				Neuromuscular blocking effects Aminoglycosides
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 Cisatracurium and Kanamycin

Recommended Action
Management		The use of aminoglycosides should generally be avoided during and immediately after surgery in which neuromuscular blockers have been employed. If these agents are used concurrently, vital signs should be closely monitored and drug dosages adjusted accordingly. In addition, ventilatory support should be readily available in case of respiratory arrest. Treatment with anticholinesterases and calcium may not always be effective in reversing the neuromuscular blockade caused by these agents.

References
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2	Chapple DJ, Clark JL, Hughes R "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth 55 Suppl (1983): s17-22. [PMID: 6688011]
3	Dupuis JY, Martin R, Tetrault JP "Atracurium and vecuronium interaction with gentamicin and tobramycin." Can J Anaesth 36 (1989): 407-11. [PMID: 2569365]
4	Geha DG, Blitt CD, Moon BJ "Prolonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report." Anesth Analg 55 (1976): 343-5. [PMID: 945014]
5	Giala M, Sareyiannis C, Cortsaris N, Paradelis A, Lappas DG "Possible interaction of pancuronium and tubocurarine with oral neomycin." Anaesthesia 37 (1982): 776. [PMID: 7103026]
6	Giala MM, Paradelis AG "Two cases of prolonged respiratory depression due to interaction of pancuronium with colistin and streptomycin." J Antimicrob Chemother 5 (1979): 234-5. [PMID: 429254]
7	Hasfurther DL, Bailey PL "Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin." Can J Anaesth 43 (1996): 617-20. [PMID: 8773869]
8	Jedeikin R, Dolgunski E, Kaplan R, Hoffman S "Prolongation of neuromuscular blocking effect of vecuronium by antibiotics." Anaesthesia 42 (1987): 858-60. [PMID: 2889390]
9	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]
10	Levanen J, Nordman R "Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride." Ann Clin Res 7 (1975): 47-9. [PMID: 1155911]
11	Lippmann M, Yang E, Au E, Lee C "Neuromuscular blocking effects of tobramycin, gentamicin, and cefazolin." Anesth Analg 61 (1982): 767-70. [PMID: 7201757]
12	Pittinger CB, Eryasa Y, Adamson R "Antibiotic-induced paralysis." Anesth Analg 49 (1970): 487-501. [PMID: 4102601]
13	Product Information. Arikayce (amikacin liposome). Insmed Incorporated, Bridgewater, NJ.
14	Product Information. Humatin (paromomycin). Parke-Davis, Morris Plains, NJ.
15	Regan AG, Perumbetti PP "Pancuronium and gentamicin interaction in patients with renal failure." Anesth Analg 59 (1980): 393. [PMID: 6989291]
16	Vanacker BF, Van de Walle J "The neuromuscular blocking action of vecuronium in normal patients and in patients with no renal function and interaction vecuronium- tobramycin in renal transplant patients." Acta Anaesthesiol Belg 37 (1986): 95-9. [PMID: 2875595]
17	Warner WA, Sanders E "Neuromuscular blockade associated with gentamicin therapy." JAMA 215 (1971): 1153-4. [PMID: 4250687]