Drug interactions
Atracurium + Physostigmine
Severity: Moderate
Atracurium and Physostigmine: 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
Physostigmine inhibits acetylcholinesterase, increasing acetylcholine at the neuromuscular junction, and can therefore reduce or reverse the block produced by atracurium. The result is a diminished or unpredictable neuromuscular blockade, which may complicate surgical relaxation.
What this interaction means in plain words
Atracurium and Physostigmine 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.
Why it happens
Cholinesterase inhibition raises acetylcholine levels that compete with the nondepolarizing blocker at nicotinic receptors.
What to do
Monitor neuromuscular function with a train-of-four monitor and expect higher atracurium requirements if physostigmine has been given. Avoid physostigmine during maintenance of the block unless reversal is intended.
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
Frequently asked questions
Can I take Atracurium with Physostigmine?
MediHelp rates the interaction as moderate. Atracurium and Physostigmine 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. Physostigmine inhibits acetylcholinesterase, increasing acetylcholine at the neuromuscular junction, and can therefore reduce or reverse the block produced by atracurium. The result is a diminished or unpredictable neuromuscular blockade, which may complicate surgical relaxation.
How serious is the interaction between Atracurium and Physostigmine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor neuromuscular function with a train-of-four monitor and expect higher atracurium requirements if physostigmine has been given. Avoid physostigmine during maintenance of the block unless reversal is intended.
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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