Drug interactions
Cisatracurium + Colistin
Severity: Major
Cisatracurium and Colistin: major 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
Colistin (polymyxin E) can cause neuromuscular blockade by itself and may potentiate non-depolarizing relaxants such as cisatracurium. Prolonged paralysis and respiratory failure have been described with polymyxins.
What this interaction means in plain words
Cisatracurium and Colistin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cisatracurium belongs to Musculoskeletal; Colistin belongs to Anti Bacterial.
Why it happens
Colistin reduces presynaptic acetylcholine release and stabilizes the postsynaptic membrane, adding to nicotinic receptor blockade by cisatracurium.
What to do
Avoid co-administration where possible; if unavoidable, reduce cisatracurium dosing and monitor with train-of-four. Have ventilatory support available, and note that calcium or neostigmine may only partly reverse the effect.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Cisatracurium
Other interactions of Colistin
- Colistin + Polymyxin b Contraindicated
- Amikacin + Colistin Major
- Amphotericin b deoxycholate + Colistin Major
- Amphotericin b + Colistin Major
- Atracurium + Colistin Major
- Bacitracin + Colistin Major
Frequently asked questions
Can I take Cisatracurium with Colistin?
MediHelp rates the interaction as major. Cisatracurium and Colistin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Colistin (polymyxin E) can cause neuromuscular blockade by itself and may potentiate non-depolarizing relaxants such as cisatracurium. Prolonged paralysis and respiratory failure have been described with polymyxins.
How serious is the interaction between Cisatracurium and Colistin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid co-administration where possible; if unavoidable, reduce cisatracurium dosing and monitor with train-of-four. Have ventilatory support available, and note that calcium or neostigmine may only partly reverse the effect.
What other medicines interact with Cisatracurium?
MediHelp also lists interactions of Cisatracurium with, for example, Amikacin, Bacitracin-neomycin-polymyxin, Benzhydrocodone / acetaminophen. The full list is on the Cisatracurium page.
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