Gallamine and Gentamicin Topical: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Gentamicin Topical
Gallamine
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.
What happens
Enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis
Interaction Deep Dive
Aminoglycoside antibiotics possess nondepolarizing neuromuscular blocking activity, which is additive or synergistic with the effects of the nondepolarizing neuromuscular blocking agents used in anesthesia3. Aminoglycosides cause presynaptic inhibition of acetylcholine release and postsynaptic reduction in sensitivity 456. Respiratory depression or prolonged apnea has been well documented with combinations of aminoglycosides and nondepolarizing neuromuscular blockers 278910. Respiratory depression has occurred following various aminoglycoside routes of administration, including intravenous, intraperitoneal, intramuscular, oral, intraluminal, intrapleural, and irrigation.
Why it happens (mechanism)
Additive or synergistic neuromuscular blockade
Literature reports
2 reports — tap to read
a) Aminoglycosides show a significant increase in clinical duration and time to recovery in patients paralyzed with vecuronium, but not with atracurium. A prospective study of 44 patients was conducted to assess the drug interactions between aminoglycosides (gentamicin and tobramycin) and atracurium and vecuronium. Twenty-two patients served as controls while the other 22 patients had therapeutic serum levels of tobramycin or gentamicin. Units of measure included onset time, clinical duration, and time to spontaneous recovery of T4/T1 ratio of 70% after atracurium or vecuronium injection. Both gentamicin and tobramycin showed a similar degree of inhibition of neuromuscular transmission in the presence of neuromuscular blocking agents. Neither aminoglycoside influenced the atracurium block, but both increased the clinical duration and the time to spontaneous recovery of T4/T1 ratio of 70% of the neuromuscular blockade induced by vecuronium. The authors speculated that the interaction between vecuronium and the aminoglycoside antibiotics could be one of synergism, which may have increased the binding of vecuronium to the neuromuscular receptors. One possible rationale for the differences seen between vecuronium and atracurium may be that atracurium possesses a shorter half-life. This study concluded that for patients treated with aminoglycoside antibiotics, atracurium may present certain advantages over vecuronium when attempting to avoid a prolonged block 1.
b) A 71-year old woman developed prolonged neuromuscular blockade due to a possible interaction between neomycin and rocuronium. The patient had a two-week history of rectal bleeding. She was given 6 grams each of erythromycin and neomycin over a two-day period in preparation for bowel surgery. During surgery, rocuronium 40 mg was administered in order to facilitate tracheal intubation and muscle relaxation. After the surgery, the patient was given neostigmine and glycopyrrolate to reverse the block. The patient appeared to respond and was extubated. She then developed weakness and dyspnea and failed to respond to further treatment with neostigmine, glycopyrrolate, and edrophonium. The patient was reintubated and was then withdrawn from ventilation with next day without further complications. The authors describe the unique quality of neomycin to produce post-tetanic exhaustion. This is an event in which patients who have a prolonged block may be able to perform single clinical tests of neuromuscular function, such as head lift, but cannot repeat them. The authors warn that this may lead an observer to believe adequate reversal of neuromuscular blockade has been achieved when, in fact, it has not 2.
Common questions
Can I take Gallamine and Gentamicin Topical together?
Enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Gallamine and Gentamicin Topical interaction?
It is rated major. Potentially serious — often needs a change or close 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 strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Gallamine or Gentamicin Topical 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 a safer alternative to one of these medications for me?
References (10)
- Dupuis JY, Martin R, & Tetrault JP: Atracurium and vecuronium interaction with gentamicin and tobramycin. Can J Anaesth 1989; 36:407-411. PubMed
- Hasfurther DL & Bailey PL: Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin. Can J Anaesth 1996; 43:617-620. DOI
- Foldes FF, Lunn JN, & Benz HG: Prolonged respiratory depression caused by drug combinations. Muscle relaxants and intraperitoneal antibiotics as etiologic agents. JAMA 1963; 183:146-147. DOI
- Levanen J & Nordman R: Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride. Ann Clin Res 1975; 7:47-49.
- Warner WA & Sanders E: Neuromuscular blockade associated with gentamicin therapy. JAMA 1971; 215:1153-1154. DOI
- Pittinger CB, Eryasa Y, & Adamson R: Antibiotic-induced paralysis. Anesth Analg 1970; 49:487-501. DOI
- Pridgen JE: Respiratory arrest thought to be due to intraperitoneal neomycin. Surgery 1956; 40:571-574.
- Geha DG, Blitt CD, & Moon BJ: Prolonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report. Anesth Analg 1976; 55:343-345. DOI
- Bennett EJ, Ramamurthy S, Dalal FY, et al: Pancuronium and the neonate. Br J Anaesth 1975; 47:75-78. PubMed
- Chapple DJ, Clark JS, & Hughes R: Interaction between atracurium and drugs used in anaesthesia. Br J Anaesth 1983; 55:17S-22S.
Keep reading about Gentamicin Topical
Keep reading about Gallamine
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