Clindamycin and Atracurium: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clindamycin
Atracurium
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
These two medicines are usually used together only in a hospital setting. Atracurium is a muscle relaxant given during surgery to keep your muscles, including the ones you breathe with, completely still. Clindamycin is an antibiotic that has its own mild muscle-relaxing effect.
When they are used together, the muscle relaxation can become stronger and last longer than expected, especially with higher antibiotic doses. That mostly matters around surgery and waking up from anesthesia. The good news is that your care team watches this closely, can adjust the dose, and is ready to support your breathing if needed. This is a well-managed situation in the operating room.
Effect: Enhanced and prolonged neuromuscular blockade when clindamycin is coadministered with the nondepolarizing agent atracurium.
Mechanism: Additive. Clindamycin has intrinsic pre- and postsynaptic activity plus a direct effect on muscle contractility, augmenting atracurium's blockade. Neither drug is a prodrug; this is a pharmacodynamic (additive), not pharmacokinetic, interaction.
Direction: Increased/prolonged effect. Onset: rapid. Evidence: probable. Dose-dependent, more pronounced with higher clindamycin doses.
- Monitor depth of block with train-of-four/quantitative neuromuscular monitoring.
- Consider reduced atracurium dosing, individualized by the anesthesia team.
- Anticipate need for prolonged respiratory/ventilatory support and delayed recovery.
What happens
Enhanced and prolonged neuromuscular blockade
Interaction Deep Dive
When clindamycin is given together with nondepolarizing muscle relaxants, the result can be an exaggerated degree of neuromuscular blockade, a risk that is heightened at larger clindamycin doses1234. Clindamycin's effect may arise from a combination of presynaptic and postsynaptic activity, along with a direct influence on the contractility of muscle.
Why it happens (mechanism)
Additive effects
How to manage this interaction
This combination is handled by your anesthesia and hospital team, not something you dose yourself. Here is what they typically do:
- Closer monitoring of your muscle and breathing function during and after surgery.
- Adjusting the atracurium dose, which may need to be lowered and individualized by your care team.
- Being ready to support your breathing until the muscle relaxant fully wears off.
What you can do: make sure your surgical and pharmacy team know you are on clindamycin before any procedure, and keep taking your medicines as prescribed unless your prescriber tells you otherwise. Bring up any questions with your pharmacist or doctor.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A 58-year-old woman with severe rheumatoid arthritis underwent wrist arthrodesis under general anesthesia. She received a small defasciculating dose of tubocurarine 3 mg along with fentanyl 1.5 mcg/kg intravenously (IV). Anesthesia was induced using thiopentone 4 mg/kg and succinylcholine 1.5 mg/kg, and was maintained with nitrous oxide in oxygen plus isoflurane. Complete recovery of neuromuscular function was noted following the succinylcholine injection. At that time, clindamycin phosphate 2400 mg IV was administered; this represented an erroneous overdose because 600 mg had been prescribed. Following surgery, the patient made no efforts at spontaneous breathing and did not respond to painful stimulation. She was managed with calcium chloride, edrophonium, atropine, and neostigmine, with minimal effect. Nine hours after surgery the patient coughed and train-of-four (TOF) had returned to 1.0. Two hours after that, she was extubated and spontaneous respiration began. The authors proposed that clindamycin produced muscle relaxation mainly through a direct effect on contractility, though some pre-synaptic effects were also considered to occur 1.
Common questions
Can I take Clindamycin and Atracurium together?
Clindamycin can make the surgical muscle relaxant atracurium work more strongly and longer, so tell your surgical team you are taking clindamycin; they will monitor you closely, adjust the dose if needed, and support your breathing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Atracurium interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Clindamycin and Atracurium interaction managed?
This combination is handled by your anesthesia and hospital team, not something you dose yourself. Here is what they typically do: Closer monitoring of your muscle and breathing function during and after surgery. Adjusting the atracurium dose, which may need to be lowered and individualized by your care team. Being ready to support your breathing until the muscle relaxant fully wears off. What you… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clindamycin or Atracurium need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (4)
- Al Ahdal O & Bevan DR: Clindamycin-induced neuromuscular blockade. Can J Anaesth 1995; 42:614-617. PubMed
- Ostergaard D, Engbaek J, & Viby-Mogensen J: Adverse reactions and interactions of the neuromuscular blocking drugs. Med Toxicol Adverse Drug Exp 1989; 4:351-368. PubMed
- Rubbo JT, Gergis SD, & Sokoll MD: Comparative neuromuscular effects of lincomycin and clindamycin. Anesth Analg 1977; 56:329-332. PubMed
- Fogdall RP & Miller RD: Prolongation of a pancuronium-induced neuromuscular blockade by clindamycin. Anesthesiology 1974; 41:407-408. PubMed
Keep reading about Clindamycin
Keep reading about Atracurium
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