Drug interactions
Atracurium + Neostigmine
Severity: Moderate
Atracurium and Neostigmine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Neostigmine is a cholinesterase inhibitor that is intentionally used to reverse non-depolarizing blockade by atracurium. It increases acetylcholine at the neuromuscular junction and overcomes the block, so the effect of atracurium is antagonized.
What this interaction means in plain words
Atracurium and Neostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Atracurium belongs to Musculoskeletal; Neostigmine belongs to Central Nervous System.
Why it happens
Cholinesterase inhibition raises acetylcholine, which competitively overcomes atracurium at nicotinic receptors.
What to do
Give neostigmine only when spontaneous recovery has begun, guided by train-of-four monitoring, and combine with an antimuscarinic such as glycopyrrolate to limit muscarinic effects. Do not give it before the intended end of blockade.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Atracurium
Other interactions of Neostigmine
Frequently asked questions
Can I take Atracurium with Neostigmine?
MediHelp rates the interaction as moderate. Atracurium and Neostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Neostigmine is a cholinesterase inhibitor that is intentionally used to reverse non-depolarizing blockade by atracurium. It increases acetylcholine at the neuromuscular junction and overcomes the block, so the effect of atracurium is antagonized.
How serious is the interaction between Atracurium and Neostigmine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Give neostigmine only when spontaneous recovery has begun, guided by train-of-four monitoring, and combine with an antimuscarinic such as glycopyrrolate to limit muscarinic effects. Do not give it before the intended end of blockade.
What other medicines interact with Atracurium?
MediHelp also lists interactions of Atracurium with, for example, Amikacin, Bacitracin-neomycin-polymyxin, Benzhydrocodone / acetaminophen. The full list is on the Atracurium page.
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