Drug General Information (ID: DDIY4L7ABS)
  Drug Name Neomycin (topical) Drug Info Doxacurium Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antibiotics Analgesics
  Structure

 Mechanism of Neomycin (topical)-Doxacurium Interaction (Severity Level: Moderate)
     Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Neomycin (topical) Doxacurium
      Mechanism Neuromuscular blocking effects
Aminoglycosides 
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 Neomycin (topical) and Doxacurium 

Recommended Action
      Management Topically applied aminoglycosides may be systemically absorbed, and significant absorption could occur in certain circumstances (e.g., application to burnt or broken skin use of large quantities or on large areas for prolonged periods). Clinicians should be aware of the potential for interaction if neuromuscular blockers are used in patients who have been treated extensively with topical aminoglycosides. Vital signs should be closely monitored, and 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
1 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]
2 Regan AG, Perumbetti PP "Pancuronium and gentamicin interaction in patients with renal failure." Anesth Analg 59 (1980): 393. [PMID: 6989291]
3 Warner WA, Sanders E "Neuromuscular blockade associated with gentamicin therapy." JAMA 215 (1971): 1153-4. [PMID: 4250687]