Interactions : אינטראקציות

4.5 Interactions with other medicinal products and other forms of interaction

The following drugs have been shown to influence the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents.

Effect of other drugs on Esmeron

Increased effect:
•   Halogenated volatile anaesthetics potentiate the neuromuscular block of Esmeron. The effect only becomes apparent with maintenance dosing (see section 4.2). Reversal of the block with acetylcholinesterase inhibitors could also be inhibited.
•   After intubation with suxamethonium (see section 4.4).
•   Long-term concomitant use of corticosteroids and Esmeron in the ICU may result in prolonged duration of neuromuscular block or myopathy (see sections 4.4 and 4.8).

Other drugs:
•   antibiotics: aminoglycoside, lincosamide and polypeptide antibiotics, acylamino-penicillin antibiotics.
•   diuretics, quinidine and its isomer quinine, magnesium salts, calcium channel blocking agents, lithium salts, local anaesthetics (lidocaine i.v, bupivacaine epidural) and acute administration of phenytoin or β-blocking agents.

Recurarisation has been reported after post-operative administration of: aminoglycoside, lincosamide, polypeptide and acylamino-penicillin antibiotics, quinidine, quinine and magnesium salts (see section 4.4).

Decreased effect:
•   Prior chronic administration of phenytoin or carbamazepine.
•   Calcium chloride, potassium chloride.
•   Protease inhibitors (gabexate, ulinastatin).

Variable effect:
•   Administration of other non-depolarising neuromuscular blocking agents in combination with Esmeron may produce attenuation or potentiation of the neuromuscular block, depending on the order of administration and the neuromuscular blocking agent used.
•   Suxamethonium given after the administration of Esmeron may produce potentiation or attenuation of the neuromuscular blocking effect of Esmeron.

Effect of Esmeron on other drugs

Esmeron combined with lidocaine may result in a quicker onset of action of lidocaine.
Paediatric population
No formal interaction studies have been performed. The above mentioned interactions for adults and their special warnings and precautions for use (see section 4.4) should be taken into account for paediatric patients.