Clindamycin and Tubocurarine: 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
Tubocurarine
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 add up in a way that makes your muscles stay relaxed longer than expected. Tubocurarine is a muscle relaxant used during surgery to keep muscles still. Clindamycin is an antibiotic that, on its own, can also have a mild muscle-relaxing effect. Together, they can make the muscle relaxation stronger and last longer, which can affect the muscles you use to breathe.
The good news is that this is very well understood by the surgical and anesthesia team. They watch this closely, can adjust the muscle relaxant dose, and are fully ready to support your breathing if needed. If you are worried, ask your doctor or pharmacist.
Effect: Additive enhancement and prolongation of neuromuscular blockade when clindamycin is combined with the nondepolarizing agent tubocurarine.
- Mechanism: Additive; clindamycin exerts pre- and postsynaptic effects plus direct action on muscle contractility.
- Direction: Increased/prolonged blockade, dose-dependent (greater with higher clindamycin doses).
- Onset: Rapid. Evidence: Probable.
- Management: Monitor neuromuscular function (e.g., train-of-four), consider reducing the tubocurarine dose, and anticipate the need for ventilatory/respiratory support. Neither agent is metabolically activated, so this is a pharmacodynamic, not PK, interaction.
What happens
Enhanced and prolonged neuromuscular blockade
Interaction Deep Dive
Giving clindamycin together with nondepolarizing muscle relaxants can lead to excessive neuromuscular blockade, particularly when clindamycin is administered at higher doses1234. Clindamycin's effect may arise from both presynaptic and postsynaptic activity, in addition to a direct influence on muscle contractility.
Why it happens (mechanism)
Additive effects
How to manage this interaction
If you need both of these medicines, your care team can manage this safely.
- Keep taking or receiving both exactly as prescribed unless your team tells you otherwise.
- The anesthesia team will monitor your muscle and breathing function closely during and after the procedure.
- Your tubocurarine dose may be reduced and individualized by your care team.
- The team will be ready to provide breathing (respiratory) support if needed.
Let your surgeon, anesthesiologist, or pharmacist know you are taking clindamycin before any procedure that uses a muscle relaxant.
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 while under general anesthesia. She received a small defasciculating dose of tubocurarine 3 mg together 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 along with isoflurane. Complete recovery of neuromuscular function was noted following the succinylcholine injection. At this stage, clindamycin phosphate 2400 mg IV was administered; this represented an accidental overdose because 600 mg had been prescribed. Following surgery, the patient did not attempt any spontaneous breathing and failed to respond to painful stimulation. She received calcium chloride, edrophonium, atropine, and neostigmine, with minimal effect. Nine hours after surgery the patient coughed and the train-of-four (TOF) had recovered 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 certain pre-synaptic effects were also considered to occur 1.
Common questions
Can I take Clindamycin and Tubocurarine together?
Clindamycin can make the muscle relaxant tubocurarine work stronger and last longer, including effects on breathing muscles. Your anesthesia team manages this by monitoring closely, possibly lowering the relaxant dose, and being ready to support breathing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Tubocurarine 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 Tubocurarine interaction managed?
If you need both of these medicines, your care team can manage this safely. Keep taking or receiving both exactly as prescribed unless your team tells you otherwise. The anesthesia team will monitor your muscle and breathing function closely during and after the procedure. Your tubocurarine dose may be reduced and individualized by your care team. The team will be ready to provide breathing (respi… 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 Tubocurarine 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 Tubocurarine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist