Drug General Information (ID: DDIZDBA4VI)
Drug Name			Botulinum toxin type A		Drug Info		Amikacin		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Muscle Relaxants				Antibiotics

Mechanism of Botulinum toxin type A-Amikacin Interaction (Severity Level: Major)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Drug Name		Botulinum toxin type A				Amikacin
Mechanism		Neuromuscular blocking effects				Neuromuscular blocking effects
Key Mechanism Factor 1
		Factor Name		Neuromuscular blocking effects
		Factor Description		Neuromuscular blocking agents cause paralysis of affected skeletal muscles by blocking postsynaptic acetylcholine (Nm) receptors, thereby blocking neuromuscular signaling at the neuromuscular junction. Neuromuscular blocking agents can cause the following side effects: muscle paralysis, jaw stiffness, and shortness of breath. Concomitant use of drugs with neuromuscular blocking activity may result in severe and/or prolonged respiratory depression.
Mechanism Description		Additive neuromuscular blocking effects by the combination of Botulinum toxin type A and Amikacin

Recommended Action
Management		Caution is advised when botulinum toxin is used in combination with neuromuscular blockers, aminoglycoside antibiotics, or other drugs that can interfere with neuromuscular transmission. These drugs should be avoided in patients suspected of having botulinum toxin overdose or poisoning. Because the effects of botulinum toxin products may spread from the area of injection, patients should be monitored closely for adverse effects such as asthenia, generalized muscle weakness, diplopia, blurred vision, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties, which can occur hours to weeks after injection.

References
1	Product Information. Myobloc (botulinum toxin type B) Elan Pharmaceuticals, S. San Francisco, CA.
2	Product Information. Dysport (abobotulinumtoxinA). Tercica Inc, Brisbane, CA.
3	Product Information. Jeuveau (prabotulinumtoxinA). Evolus, Inc., Santa Barbara, CA.