Drug interactions
Cisatracurium + Pyridostigmine
Severity: Moderate
Cisatracurium and Pyridostigmine: 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
Pyridostigmine, a cholinesterase inhibitor, antagonizes non-depolarizing blockers such as cisatracurium. Patients with myasthenia gravis on pyridostigmine are typically very sensitive to these blockers, so dosing is unpredictable and the net effect depends on the underlying disease.
What this interaction means in plain words
Cisatracurium and Pyridostigmine 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; Pyridostigmine belongs to Central Nervous System.
Why it happens
Pharmacodynamic antagonism: increased acetylcholine at the neuromuscular junction opposes competitive nicotinic blockade.
What to do
Start with a markedly reduced cisatracurium dose and titrate using train-of-four monitoring, especially in myasthenia gravis. Plan for postoperative ventilatory support if needed.
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 Pyridostigmine
Frequently asked questions
Can I take Cisatracurium with Pyridostigmine?
MediHelp rates the interaction as moderate. Cisatracurium and Pyridostigmine 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. Pyridostigmine, a cholinesterase inhibitor, antagonizes non-depolarizing blockers such as cisatracurium. Patients with myasthenia gravis on pyridostigmine are typically very sensitive to these blockers, so dosing is unpredictable and the net effect depends on the underlying disease.
How serious is the interaction between Cisatracurium and Pyridostigmine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Start with a markedly reduced cisatracurium dose and titrate using train-of-four monitoring, especially in myasthenia gravis. Plan for postoperative ventilatory support if needed.
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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