The following medicinal products have been shown to influence the magnitude and/or duration of the effect of non-depolarizing neuromuscular blocking agents: Increased effect: Halogenated volatile anaesthetics potentiate the neuromuscular block of rocuronium bromide. The effect only becomes apparent with maintenance dosing (see Dosage & Administration). Reversal of the block with acetylcholinesterase inhibitors could also be inhibited.
After intubation with suxamethonium (see Precautions).
High doses of: thiopental, methohexital, ketamine, fentanyl, gammahydroxybutyrate, etomidate and propofol.
Other non-depolarizing neuromuscular blocking agents.
Prior administration of suxamethonium (see Precautions).
Long term concomitant use of corticosteroids and Rocuronium in the ICU may result in prolonged duration of neuromuscular block or myopathy (see Precautions and Adverse Reactions).
Other medicinal products: Antibiotics: aminoglycosides, lincosamides (e.g. lincomycin and clindamycin), polypeptide antibiotics, acylamino-penicillin antibiotics, tetracyclines, high doses of metronidazole; Diuretics, thiamine, MAO inhibiting agents, quinidine and its isomer quinine, protamine, adrenergic blocking agents; Magnesium salts, calcium channel blocking agents, lithium salts, local anaesthetics (lidocaine i.v., bupivacaine epidural) and acute administration of phenytoin or β-blocking agents.
Recurarization has been reported after post-operative administration of: aminoglycoside, lincosamide, polypeptide and acylamino-penicillin antibiotics, quinidine, quinine and magnesium salts (see Precautions).
Decreased effect: Neostigmine, edrophonium, pyridostigmine, aminopyridine derivatives; Prior chronic administration of corticosteroids, phenytoin or carbamazepine; Noradrenaline, azathioprine (only transient and limited effect), theophylline, calcium chloride, potassium chloride; protease inhibitors (gabexate, ulinastatin).
Variable effect: Administration of other non-depolarizing neuromuscular blocking agents in combination with rocuronium bromide may produce attenuation or potentiation of the neuromuscular block, depending on the order of administration and the neuromuscular blocking agent used.
Suxamethonium given after the administration of rocuronium bromide may produce potentiation or attenuation of the neuromuscular blocking effect of rocuronium bromide.
Effect of rocuronium bromide on other medicinal products: Rocuronium bromide combined with lidocaine may result in a quicker onset of action of lidocaine.
Paediatric patients: No formal interaction studies have been performed. The previously mentioned interactions for adults and their special warnings and precautions for use (see Precautions) should also be taken into account for paediatric patients.