Some drugs enhance or inhibit the response to<unk>  which require the dosage adjustment guided by monitoring. Combination of<unk>  In some clinical circumstances, succinylcholine may be administered before and after a nondepolarising<unk> or two different nondepolarising<unk>  are administered in sequence. Combining different<unk>  can result in different degrees of neuromuscular block and management should be guided with the use of a neuromuscular function monitor. The administration of nondepolarising<unk> has an antagonistic effect on the subsequent depolarising block induced by succinylcholine. If a nondepolarising<unk> is administered prior to succinycholine, the dose of succinylcholine must be increased. The administration of succinylcholine on the subsequent administration of a nondepolarising neuromuscular block depends on the drug used. Studies have shown that administration of succinylcholien before a nondepolarising<unk> does not affect the potency of mivacurium or rocuronium. But for vecuronium and cisatracurium, it speeds up the onset, increases the potency and prolongs the duration of action. Combining two nondepolarising<unk>  of the same chemical class (e.g. rocuronium and vecuronium) produces an additive effect, while combining two nondepolarising<unk>  of different chemical class (e.g. rocuronium and cisatracurium) produces a synergistic response. Inhaled anesthetics Inhaled anesthetics inhibit nicotinic acetylcholine receptors (nAChRs) and potentiate neuromuscular blockage with nondepolarising<unk> . It depends on the type of volatile anesthetic (desflurane > sevoflurane > isoflurane > nitrous oxide), the concentration and the duration of exposure. Antibiotics Tetracycline, aminoglycosides, polymyxins and clindamycin potentiate neuromuscular blockage by inhibiting ACh release or desensitisation of post-synpatic nAChRs to ACh. This interaction happens mostly during maintenance of anesthesia. As antibiotics typically are given after a dose of<unk>  this interaction needs to be considered when re-dosing<unk>  Anti-seizure drugs Patients receiving chronic treatment are relatively resistance to nondepolarising<unk>  due to the accelerated clearance. Lithium Lithium is structurally similar to other cations such as sodium, potassium, magnesium and calcium, this causes lithium to activate potassium channels which inhibit neuromuscular transmission. Patients who take lithium can have a prolonged response to both depolarising and nondepolarising<unk> . Antidepressants Sertraline and amitriptyline inhibit butyrylcholinesterase and cause prolonged paralysis. Mivacurium causes prolonged paralysis for patients chronically taking sertraline. Local anesthetics (LAs) LAs may enhance the effects of depolarisation and nondepolarising<unk>  through pre and post-synaptic interactions at the NMJ. It may result in blood levels high enough to potentiate<unk> induced neuromuscular block. Epidurally administered levobupivacaine and mepivacaine potentiate amino-steroidal<unk>  and delay recovery from neuromuscular blockade.
Neuromuscular blocking agents
Neuromuscular-blocking drug
Cholinergic blocking drugs
Muscle relaxant
Antiarrhythmic agent
Antihypotensive agent
Steroid
Neuroleptanalgesic