Clindamycin and Metocurine: 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
Metocurine
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 can work together in a way that makes muscles stay relaxed longer than expected. Metocurine is a muscle relaxant used during surgery to keep your muscles still. Clindamycin is an antibiotic, and it can add to that muscle-relaxing effect, especially at higher doses.
When they combine, the relaxing effect can be stronger and last longer, which can even affect the muscles you use to breathe. The good news is that this almost always happens in a hospital or surgery setting, where your care team watches you closely and can adjust things and support your breathing if needed. Your team knows how to manage this.
Effect: Enhanced and prolonged neuromuscular blockade when clindamycin is given with the nondepolarizing agent metocurine.
Mechanism: Additive/synergistic. Clindamycin exerts pre- and postsynaptic neuromuscular effects plus direct action on muscle contractility, potentiating the blockade. Neither agent is metabolically activated in a way that changes direction; this is a pharmacodynamic (additive) interaction.
- Direction: Increased neuromuscular blockade (increased drug effect)
- Onset: Rapid; Evidence: Probable; Severity: Moderate
- Dose-related: More likely with higher clindamycin doses
Management: Monitor closely for excessive/prolonged blockade. A metocurine dose reduction may be advantageous. Anticipate the possible need for respiratory support.
What happens
Enhanced and prolonged neuromuscular blockade
Interaction Deep Dive
When clindamycin is given together with nondepolarizing muscle relaxants, the result can be excessive neuromuscular blockade, particularly at elevated clindamycin doses1234. Clindamycin's effect may arise from a combination of presynaptic and postsynaptic activity, along with a direct impact on muscle contractility.
Why it happens (mechanism)
Additive effects
How to manage this interaction
This interaction is handled by your care team, not something you manage at home, since metocurine is given during procedures with monitoring.
- Closer monitoring: Your team will watch for muscle relaxation that is stronger or lasts longer than expected.
- Dose tailoring: The metocurine dose may need to be adjusted and individualized by your care team, especially if higher clindamycin doses are used.
- Breathing support: Your team will be prepared to provide respiratory support if needed.
If you are receiving both, mention any current antibiotics to your surgical or anesthesia team so they can plan ahead.
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 with general anesthesia. She received a small defasciculating dose of tubocurarine 3 mg along with fentanyl 1.5 mcg/kg intravenously (IV). Induction of anesthesia used thiopentone 4 mg/kg and succinylcholine 1.5 mg/kg, and maintenance was achieved with nitrous oxide in oxygen and isoflurane. Neuromuscular activity returned completely following the anticipated recovery from succinylcholine-induced paralysis. An intraoperative dose of clindamycin phosphate 2400 mg IV was then mistakenly administered, rather than the ordered clindamycin 600 mg dose. After surgery, the patient did not breathe spontaneously and showed no response to painful stimulation. She received calcium chloride, edrophonium, atropine, and neostigmine, with minimal effect. Nine hours after surgery, the patient coughed and train-of-four had returned to 1.0. Two hours later, she was extubated and spontaneous respiration began. The authors proposed that clindamycin produced muscle relaxation mainly through a direct effect on contractility, although some pre-synaptic effects were also thought to be involved 1.
Common questions
Can I take Clindamycin and Metocurine together?
Clindamycin can make the muscle relaxant metocurine work more strongly and for longer, including effects on breathing muscles. This is managed in a monitored setting where the dose can be lowered and breathing support provided if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Metocurine 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 Metocurine interaction managed?
This interaction is handled by your care team, not something you manage at home, since metocurine is given during procedures with monitoring. Closer monitoring: Your team will watch for muscle relaxation that is stronger or lasts longer than expected. Dose tailoring: The metocurine dose may need to be adjusted and individualized by your care team, especially if higher clindamycin doses are used. B… 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 Metocurine 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 Metocurine
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