Interaction between Paromomycin and Atracurium
Major
Synergy
| ID | DDInter1396 and DDInter135 |
| Interaction | Aminoglycosides possess neuromuscular blocking activity, which may be additive with that of depolarizing and nondepolarizing muscle relaxants, potentially resulting in severe and/or prolonged respiratory depression during concomitant use. Aminoglycosides inhibit the release of acetylcholine at neuromuscular junctions by interfering with calcium influx. They also appear to decrease the sensitivity of postsynaptic membrane to acetylcholine. The interaction has been observed with various routes of aminoglycoside administration including oral, intramuscular, intravenous, intraperitoneal, esophageal, intraluminal, intradural, and beneath skin flaps. Respiratory paralysis and fatalities have been reported. Patients at increased risk include those with renal impairment and/or hypocalcemia. |
| 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 | |
| Alternative for Paromomycin |
A07A
|
| Alternative for Atracurium |
M03A
|
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.