Clindamycin and Mivacurium: 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
Mivacurium
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 around surgery. Mivacurium is a muscle relaxant given during an operation to keep your muscles from moving, including the muscles you use to breathe. Clindamycin is an antibiotic that, on its own, can also have a mild relaxing effect on muscles.
When they are used together, the muscle-relaxing effect can become stronger and last longer than expected, especially with higher doses of clindamycin. The good news is that this happens in a monitored setting. Your anesthesia team watches your muscle strength and breathing closely and can adjust the medicine and support your breathing if needed.
Effect: Enhanced and prolonged neuromuscular blockade when clindamycin is coadministered with the nondepolarizing agent mivacurium.
Mechanism: Additive (PD) effect. Clindamycin exerts pre- and postsynaptic neuromuscular activity plus a direct depressant effect on muscle contractility, augmenting mivacurium's blockade. Neither drug is a prodrug; this is a pharmacodynamic, not metabolic, interaction.
- Direction: Increased/prolonged blockade (dose-dependent, worse with higher clindamycin doses)
- Onset: Rapid
- Evidence: Theoretical
Management: Monitor depth of block (train-of-four), consider a reduced mivacurium dose, and anticipate the need for prolonged respiratory/ventilatory support and adequate reversal.
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 higher clindamycin doses1234. This effect of clindamycin may arise from a combination of presynaptic and postsynaptic activity along with a direct influence on muscle contractility.
Why it happens (mechanism)
Additive effects
How to manage this interaction
This combination is managed by your anesthesia and surgical team, so you do not need to change anything yourself.
- Keep taking clindamycin as prescribed and tell your surgical and anesthesia team about it before any procedure.
- Your team may monitor your muscle strength and breathing more closely during and after surgery.
- The mivacurium dose may be adjusted and individualized by your care team.
- They will be ready to support your breathing until the blockade fully wears off.
If you have questions about your antibiotic before a planned surgery, raise them with your pharmacist or prescriber.
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 and 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 accidental overdose because 600 mg had been ordered. Following surgery, the patient made no efforts at spontaneous ventilation 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 the train-of-four (TOF) had returned to 1.0. Two hours later, she was extubated and spontaneous breathing followed. The authors proposed that clindamycin produced muscle relaxation mainly through a direct effect on contractility, although some pre-synaptic effects were also considered to occur 1.
Common questions
Can I take Clindamycin and Mivacurium together?
Clindamycin can make the surgical muscle relaxant mivacurium work stronger and longer, so your anesthesia team monitors your breathing and muscle strength and may lower the mivacurium dose. This is handled in a controlled setting, so no action is needed on your part beyond telling your team you take clindamycin. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Mivacurium 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 Mivacurium interaction managed?
This combination is managed by your anesthesia and surgical team, so you do not need to change anything yourself. Keep taking clindamycin as prescribed and tell your surgical and anesthesia team about it before any procedure. Your team may monitor your muscle strength and breathing more closely during and after surgery. The mivacurium dose may be adjusted and individualized by your care team. They… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
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 Mivacurium 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 Mivacurium
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