Neuromuscular blockers Aminoglycosides

Magnesium ions and the aminoglycosides have neuromuscular blocking activity, which can be additive (see also Neuromuscular blockers + Magnesium compounds , p.l25 and Neuromuscular blockers + Aminoglycosides , p.ll3). In the case cited here it seems that it was enough to block the actions of the respiratory muscles. 

Drugs that may be affected by aminoglycosides include depolarizing and nondepolarizing neuromuscular blockers and polypeptide antibiotics. 

WARNING Systemic absorption of oral route may cause neuro/oto/nephrotox may result resp paralysis possible w/ any route of administration Uses Hepatic coma, bowel prq) Action Aminoglycoside, poorly absorbed PO -1- GI bacterial flora Dose Adults. 3-12 g/24- h PO in 3-4 doses Peds. 50-1 (X) mg/kg/24 h PO in 3-4 doses Caution [C, /-] Renal failure, neuromuscular disorders, hearing impair Contra Intestinal obst Disp Tabs, PO soln SE Hearing loss w/ long-term use rash, NA EMS Use neuromuscular blockers w/ caution, reduced dose may be necessary t bleeding risk w/ concurrent anticoagulant use OD May cause neuromuscular block and kidney failure calcium salts can be used to revise neuromuscular block... 

Vancomycin Hydrochloride Solutions of vancomycin hydrochloride have an acid pH and incompatibility may reasonably be expected with alkaline preparations or drugs unstable at low pH. Vancomycin interacts with aminoglycosides, loop diuretics, general anesthetics, and neuromuscular blockers. 

Indications Neuromuscular blockade, endotracheal intubation Category Non-depolarizing neuromuscular blocker Half-life initial 2 minutes terminal 20 minutes Clinically important, potentially hazardous interactions with amikacin, aminoglycosides, anesthetics, antibiotics, gentamicin, halothane, kanamycin, neomycin, piperacillin, streptomycin, tobramycin... 

Clinically important, potentially hazardous interactions with adefovir, aldesleukin, aminoglycosides, atracurium, bumetanide, doxacurium, ethacrynic acid, furosemide, neuromuscular blockers, pancuronium, polypeptide antibiotics, rocuronium, succinylcholine, teicoplanin, torsemide, vecuronium... 

Interactions Inhaled anesthetics, especially isoflurane, strongly potentiate and prolong neuromuscular blockade. Aminoglycoside antibiotics and antiarrhythmic drugs potentiate and prolong the relaxant action of neuromuscular blockers to a lesser degree. 

Neuromuscular blockers + Drugs with neuromuscular blocking effects (e.g. Aminoglycosides) Increased neuromuscular blocloid delayed recovery, prolonged apnoea... 

Aminoglycosides and neuromuscular blockers that have been reported not to interact are ... 

Animal studies indicate that low and otherwise safe doses of lidocaine given with other drugs having neuromuscular blocking activity (e.g. polymyxin B, aminoglycosides) may possibly be additive with conventional neuromuscular blockers and so some caution may be warranted. ... 

Administration of the aminoglycosides with the cephalosporins may increase the risks of nephrotoxicity. When the aminoglycosides are administered with loop diuretics there is an increased risk of ototoxicity (irreversible hearing loss). There is an increased risk of neuromuscular blockage (paralysis of the respiratory muscles) if the aminoglycosides are given shortly after general anesthetics (neuromuscular junction blockers). 

The effect of administering different botulinum neurotoxin serotypes at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Aminoglycosides Cautiously perform coadministration of botulinum toxin type A and aminoglycosides or other agents interfering with neuromuscular transmission (eg, curare-like nondepolarizing blockers, lincosamides, polymyxins, quinidine, magnesium sulfate, anticholinesterases, succinylcholine chloride) because the effect of the toxin may be potentiated. 

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