Interactions : אינטראקציות

4.5    Interaction with other medicinal products and other forms of interaction

The neuromuscular block produced by Tracrium may be increased by the concomitant use of inhalational anaesthetics such as halothane, isoflurane and enflurane.

In common with all non-depolarising neuromuscular blocking agents the magnitude and/or duration of a non-depolarising neuromuscular block may be increased as a result of interaction with: - antibiotics, including the aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin and clindamycin
- anti-arrhythmic drugs: propranolol, calcium channel blockers, lidocaine, procainamide and quinidine
- diuretics: furosemide and possibly mannitol, thiazide diuretics and acetazolamide - magnesium sulfate
- ketamine
- lithium salts
- ganglion blocking agents, trimetaphan, hexamethonium.

Rarely certain drugs may aggravate or unmask latent myasthenia gravis or actually induce a myasthenic syndrome; increased sensitivity to Tracrium would be consequent on such a development.
Such drugs include various antibiotics, β-blockers (propranolol, oxprenolol), antiarrhythmic drugs (procainamide, quinidine), antirheumatic drugs (chloroquine, D-penicillamine), trimetaphan, chlorpromazine, steroids, phenytoin and lithium.
The onset of non-depolarising neuromuscular block is likely to be lengthened and the duration of block shortened in patients receiving chronic anticonvulsant therapy.

The administration of combinations of non-depolarising neuromuscular blocking agents in conjunction with Tracrium may produce a degree of neuromuscular blockage in excess of that which might be 
expected were an equipotent total dose of Tracrium administered. Any synergistic effect may vary between different drug combinations.

A depolarising muscle relaxant such as suxamethonium chloride should not be administered to prolong the neuromuscular blocking effects of non-depolarising blocking agents such as atracurium, as this may result in a prolonged and complex block which can be difficult to reverse with anticholinesterase drugs.

Treatment with anticholinesterases, commonly used in the treatment of Alzheimer’s disease e.g.
donepezil, may shorten the duration and diminish the magnitude of neuromuscular blockade with atracurium.