Drug interactions
Cisatracurium + Neostigmine
Severity: Moderate
Cisatracurium 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 used intentionally to reverse non-depolarizing neuromuscular blockade, so it opposes the effect of cisatracurium. If given too early or when blockade is deep, reversal may be incomplete; unintended exposure in patients on chronic neostigmine may cause resistance to the blocker.
What this interaction means in plain words
Cisatracurium 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.
Cisatracurium belongs to Musculoskeletal; Neostigmine belongs to Central Nervous System.
Why it happens
Pharmacodynamic antagonism: cholinesterase inhibition raises acetylcholine at the neuromuscular junction, overcoming competitive nicotinic blockade.
What to do
Give neostigmine for reversal only once spontaneous recovery has begun, guided by train-of-four monitoring. Consider sugammadex-free alternatives only per local practice, and titrate cisatracurium dosing in patients on chronic anticholinesterases.
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 Cisatracurium
Other interactions of Neostigmine
Frequently asked questions
Can I take Cisatracurium with Neostigmine?
MediHelp rates the interaction as moderate. Cisatracurium 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 used intentionally to reverse non-depolarizing neuromuscular blockade, so it opposes the effect of cisatracurium. If given too early or when blockade is deep, reversal may be incomplete; unintended exposure in patients on chronic neostigmine may cause resistance to the blocker.
How serious is the interaction between Cisatracurium 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 for reversal only once spontaneous recovery has begun, guided by train-of-four monitoring. Consider sugammadex-free alternatives only per local practice, and titrate cisatracurium dosing in patients on chronic anticholinesterases.
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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