Furosemide with Tubocurarine Interaction Details
Brand Names Associated with Furosemide
- Furosemide
- Lasix®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
Prolongation of neuromuscular blockade and antagonism of muscle relaxant effects of tubocurarine
Interaction Summary
Concomitant use of furosemide and tubocurarine may result in prolonged neuromuscular blockade or antagonism of the muscle relaxant effects of tubocurarine . Three cases of prolonged neuromuscular blockade following the administration of furosemide and tubocurarine in patients undergoing kidney transplantation have been described . Possible mechanisms for this interaction include a direct depressant effect of furosemide on the neuromuscular junction, a change in extracellular electrolyte concentration, redistribution of tubocurarine from inactive to active depot sites, and/or a decrease in intravascular and extracellular fluid volumes. Renal transplant patients are at an increased risk of prolonged neuromuscular blockade because of reduced tubocurarine elimination, and diuretics are often needed to induce diuresis in the newly transplanted kidney . Therefore, patients receiving concurrent tubocurarine and furosemide should be monitored for prolonged neuromuscular blockade or reduced muscle relaxant effects .
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Concomitant use of furosemide and tubocurarine may result in prolonged neuromuscular blockade or antagonism of the muscle relaxant effects of tubocurarine . Therefore, monitor patients receiving concurrent tubocurarine and furosemide for prolonged neuromuscular blockade or reduced muscle relaxant effects .
Mechanism Of Interaction
Additive or antagonist effects
Literature Reports
A) Three case reports of furosemide-induced prolongation of tubocurarine neuromuscular blockade have been described. In patient 1, tubocurarine 0.3 mg/kg was administered intravenously; and 43 minutes later, the twitch height was depressed by 62%. When mannitol 12.5 g and furosemide 80 mg were administered intravenously, the twitch height gradually decreased to 72% depression in 10 minutes. Forty minutes later, the twitch height returned to the same level as before the diuretics. In patient 2, tubocurarine 0.3 mg/kg was given, followed in 87 minutes by an additional tubocurarine dose of 3 mg. After 58 minutes, twitch tension was half of the control value. Intravenous mannitol 12.5 g and furosemide 80 mg were then administered. Over the next 90 minutes, the twitch tension decreased to less than 25% of the control value. Patient 3 received tubocurarine 0.5 mg/kg with 100% depression of twitch height. After the administration of intravenous mannitol 12.5 g and furosemide 40 mg, twitch height decreased from 46% to 36% of control. An additional dose of furosemide 40 mg was given 25 minutes later, and twitch height decreased to 22% of control. Plasma concentrations of tubocurarine increased from 0.75 mcg/mL (1.23 mcmol/L) prior to diuretic administration to 0.82 mcg/mL (1.34 mcmol/L) at the time of the 22% reading of twitch height. The authors postulated that since furosemide alone augmented the tubocurarine-induced neuromuscular blockade in patient 3 as much as the combination of furosemide and mannitol, mannitol has little effect on neuromuscular blockade .
Furosemide Overview
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Furosemide is used alone or in combination with other medications to treat high blood pressure. Furosemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Furosemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.