The synergistic effect of gentamicin and clindamycin on rocuronium-induced neuromuscular blockade

Lee, Ji Hyeon; Lee, Soo Il; Chung, Chan Jong; Lee, Jong Hwan; Lee, Seung Cheol; Choi, So Ron; Oh, Ji Na; Bae, Jin Ho

doi:10.4097/kjae.2013.64.2.143

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…27,29 Antibióticos A maioria dos antibióticos deprime a condução neuromuscular. 30 Os aminoglicosídeos, em doses clínicas, potencializam e prolongam o relaxamento neuromuscular adespolarizante. Bloqueiam canais de sódio voltagem-dependentes no nervo motor e possuem efeito pré e pós-sináptico nos canais nicotínicos.…”

Section: Opioidesunclassified

Adversities related to neuromuscular blockade and reversal

Alencar¹,

Louzada²,

Jorge³

et al. 2016

Revista Médica De Minas Gerais

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RESUMO Evento adverso relacionado a um fármaco é definido, pela Organização Mundial de Saúde, como uma resposta nociva e não intencional a uma droga que ocorre após o uso de doses normalmente utilizadas no homem para profilaxia, diagnóstico ou tratamento de uma doença ou para modificação de uma função fisiológica. Os bloqueadores neuromusculares (BNM) são fármacos capazes de provocar alterações indesejáveis em doses habituais e a interação com outras drogas utilizadas durante a anestesia pode potencializar, prolongar ou reverter precocemente o relaxamento neuromuscular desejado. O processo de reversão do bloqueio não é isento de riscos e complicações. Eventos adversos podem ocorrer desde o momento da administração de drogas reversoras até o período pós-operatório, no qual pode ocorrer paralisia residual. É importante reconhecer os possíveis efeitos adversos associados ao uso dessas drogas, uma vez que a escolha do BNM adequado para cada situação irá afetar diretamente o desfecho do ato anestésico.

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Section: Opioidesunclassified

Adversities related to neuromuscular blockade and reversal

Alencar¹,

Louzada²,

Jorge³

et al. 2016

Revista Médica De Minas Gerais

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“…If blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary 1112…”

Section: Introductionmentioning

confidence: 99%

Gentamicin-mediated ototoxicity and nephrotoxicity: A clinical trial study

et al. 2016

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Background:Aminoglycosides and mainly gentamicin are the most important antimicrobial agents. Two different methods of administration exist: Single and multiple doses. There has always been a controversy about the less harmful administration method, to minimize adverse effects of gentamicin – deafness and renal insufficiency. In this study, it was aimed to compare two different methods of administration to figure out the least harmful treatment method.Materials and Methods:In a clinical study, eighty patients aged 12–55 years who were admitted with sepsis syndrome were included in the study; they were divided into two groups: The first group received single-dose treatment (5 mg/kg) whereas the second group was treated with multiple doses (1.7 mg/kg three times a day) of gentamicin.Results:The results show that blood urea nitrogen (BUN) and creatinine (CR) levels were decreased in the first group. Both blood urea nitrogen and creatinine and also mean glomerular filtration rate was increased in the same group. In the second group, mean BUN and CR levels were increased while the GFR was decreased in the same group. There was also a gradual increase in GFR in the first group. GFR <80 was decreased from 20% to 5.1% in the first group while increased from 5% to 27.5% in the second group. Results of audiometric studies show 6.1% hearing problem in the first group and 12.8% in the second one.Conclusions:Results of the present study showed that nephrotoxicity and ototoxicity are minimized in single-dose administration compared to multiples doses.

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“…Also, antibiotics as aminoglycosides (e.g. gentamicin) and lincosamides (as clindamycin) poteniate neuromuscular blockade and should be used with caution (12,13). Interestingly, clindamycin, metabolized by cytochrome P450 form 3A4 (CYP3A4), was found also to be an inhibitor of this form (14).…”

Section: Introductionmentioning

confidence: 99%

Interaction of rocuronium with human liver cytochromes P450

Anzenbacherová

Špičáková

Jourová

et al. 2015

Journal of Pharmacological Sciences

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Rocuronium is a neuromuscular blocking agent acting as a competitive antagonist of acetylcholine. Results of an inhibition of eight individual liver microsomal cytochromes P450 (CYP) are presented. As the patients are routinely premedicated with diazepam, possible interaction of diazepam with rocuronium has been also studied. Results indicated that rocuronium interacts with human liver microsomal CYPs by binding to the substrate site. Next, concentration dependent inhibition of liver microsomal CYP3A4 down to 42% (at rocuronium concentration 189 μM) was found. This effect has been confirmed with two CYP3A4 substrates, testosterone (formation of 6β-hydroxytestosterone) and diazepam (temazepam formation). CYP2C9 and CYP2C19 activities were inhibited down to 75-80% (at the same rocuronium concentration). Activities of other microsomal CYPs have not been inhibited by rocuronium. To prove the possibility of rocuronium interaction with other drugs (diazepam), the effect of rocuronium on formation of main diazepam metabolites, temazepam (by CYP3A4) and desmethyldiazepam, (also known as nordiazepam; formed by CYP2C19) in primary culture of human hepatocytes has been examined. Rocuronium has caused inhibition of both reactions by 20 and 15%, respectively. The results open a possibility that interactions of rocuronium with drugs metabolized by CYP3A4 (and possibly also CYP2C19) may be observed.

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The synergistic effect of gentamicin and clindamycin on rocuronium-induced neuromuscular blockade

Cited by 20 publications

References 23 publications

Adversities related to neuromuscular blockade and reversal

Adversities related to neuromuscular blockade and reversal

Gentamicin-mediated ototoxicity and nephrotoxicity: A clinical trial study

Interaction of rocuronium with human liver cytochromes P450

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