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| Interactions: | Amphotericin B
Adverse Effect: enhanced muscle relaxation secondary to hypokalemia Clinical Management: Carefully monitor serum potassium concentrations in patients receiving Pipecuronium and amphotericin B. Clinicians should be alert to potentially enhanced muscle paralysis in these patients.
Carbamazepine
Adverse Effect: Resistance to neuromuscular blockade Clinical Management: In patients on chronic carbamazepine therapy, higher doses of pipecuronium may be needed. Monitor the depth of neuromuscular blockade and adjust the dose of pipecuronium accordingly.
Clindamycin
Adverse Effect: enhanced and prolonged neuromuscular blockade Clinical Management: If concurrent therapy with these agents is required, closely monitor patients for excessive neuromuscular blockade. A reduction in the dose of pipecuronium may be advantageous. The need for respiratory support should be anticipated.
Colistin Sulphate
Adverse Effect: enhanced or prolonged neuromuscular blockade Clinical Management: Avoid concomitant use of Colistin Sulphate and Pipecuronium. If the combination cannot be avoided, observe patients closely for enhanced or prolonged neuromuscular blockade which may require mechanical ventilation.
Dexamethasone
Adverse Effect: Decreased pipecuronium effectiveness; prolonged muscle weakness and myopathy Clinical Management: If concurrent therapy is required, monitor the effectiveness of pipecuronium and adjust the dose as required, especially in patients receiving high-dose Dexamethasone . With prolonged coadministration of these agents, consider allowing the patient to have unparalyzed periods to reduce the total dose of the neuromuscular blocker.
Gentamicin
Adverse Effect: enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Clinical Management: Avoid concomitant use of Gentamicin and Pipecuronium if possible. Concurrent use of Gentamicin and Pipecuronium requires close monitoring of the patients clinical condition, especially respiratory and oxygenation status.
Hydrocortisone
Adverse Effect: decreased effectiveness of non depolarising agents; prolonged muscle weakness and myopathy Clinical Management: If concurrent therapy is required, monitor the effectiveness of pipecuronium and adjust the dose as required, especially in patients receiving high-dose Hydrocortisone . With prolonged co-administration of these agents, consider allowing the patient to have unparalyzed periods to reduce the total dose of the neuromuscular blocker.
Lincomycin
Adverse Effect: pipecuronium toxicity (respiratory depression) Clinical Management: If concurrent therapy is required, a reduction in the dose of pipecuronium may be required. The need for respiratory support should be anticipated.
Neomycin
Adverse Effect: enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Clinical Management: Avoid concomitant use of Neomycin and Pipercuronium if possible. Concurrent use of Neomycin and Pipercuronium requires close monitoring of the patients clinical condition, especially respiratory and oxygenation status.
Netilmicin
Adverse Effect: enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Clinical Management: Avoid concomitant use of Netilmicin and Pipecuronium if possible. Concurrent use of Netilmicin and Pipecuronium requires close monitoring of the patients clinical condition, especially respiratory and oxygenation status.
Phenytoin
Adverse Effect: Resistance to neuromuscular blockade Clinical Management: In patients on chronic phenytoin therapy, higher doses of pipecuronium may be needed. Monitor the depth of neuromuscular blockade and adjust the dose of pipecuronium accordingly.
Polymyxin-B
Adverse Effect: Significant increase in the therapeutic effect of Pipecuronium # Clinical Management: Monitor for the therapeutic effect and adjust the dose accordingly.
Prednisolone
Adverse Effect: decreased effectiveness; prolonged muscle weakness and myopathy Clinical Management: If concurrent therapy is required, monitor the effectiveness of pipercuronium and adjust the dose as required, especially in patients receiving high-dose Prednisolone . With prolonged coadministration of these agents, consider allowing the patient to have unparalyzed periods to reduce the total dose of the neuromuscular blocker.
Procainamide
Adverse Effect: excessive neuromuscular blockade Clinical Management: A reduction in the pipecuronium dose may be necessary when administered with procainamide.
Quinidine
Adverse Effect: Pipecuronium toxicity (respiratory depression) Clinical Management: Quinidine should be avoided if possible in the immediate postoperative period when the effects of neuromuscular blockers may be present. If quinidine is utilized, the need for respiratory support should be anticipated.
Soframycin - Ocular
Adverse Effect: enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Clinical Management: Avoid concomitant use of Soframycin - Ocular and Pipecuronium if possible. Concurrent use of Soframycin - Ocular and Pipecuronium requires close monitoring of the patients clinical condition, especially respiratory and oxygenation status.
Streptomycin
Adverse Effect: enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Clinical Management: Avoid concomitant use of Streptomycin and Pipecuronium if possible. Concurrent use of Streptomycin and Pipecuronium requires close monitoring of the patients clinical condition, especially respiratory and oxygenation status.
Tetracycline
Adverse Effect: Significant increase in the therapeutic effect of Pipecuronium # Clinical Management: Monitor for the therapeutic effect and adjust the dose accordingly.
Tobramycin
Adverse Effect: enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Clinical Management: Avoid concomitant use of Tobramycin and Pipecuronium if possible. Concurrent use of Tobramycin and Pipecuronium requires close monitoring of the patients clinical condition, especially respiratory and oxygenation status.
Triamcinolone
Adverse Effect: Decreased pipecuronium effectiveness; prolonged muscle weakness and myopathy Clinical Management: If concurrent therapy is required, monitor the effectiveness of pipecuronium and adjust the dose as required, especially in patients receiving high-dose Triamcinolone . With prolonged coadministration of these agents, consider allowing the patient to have unparalyzed periods to reduce the total dose of the neuromuscular blocker |
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