Tracrium Drug Interactions

The neuromuscular block produced by atracurium 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.
antiarrhythmic drugs: propranolol, calcium channel blockers, lidocaine, procainamide and quinidine.
diuretics: furosemide and possibly mannitol, thiazide diuretics and acetazolamide.
magnesium sulphate; 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 atracurium would be consequent on such a development. Such drugs include various antibiotics, beta-blockers (propranolol, oxprenolol), anti-arrhythmic drugs (procainamide, quinidine), anti- rheumatic 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 anti-convulsant therapy.
The administration of combinations of non-depolarising neuromuscular blocking agents in conjunction with atracurium may produce a degree of neuromuscular blockade in excess of that which might be expected were an equipotent total dose of atracurium 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 agents such as atracurium, as this may result in a prolonged and complex block which can be difficult to reverse with anti-cholinesterase 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.