Rocuronium and Bacitracin Topical: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Bacitracin Topical
Rocuronium
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 or prolonged neuromuscular blockade
Interaction Deep Dive
Concomitant use of nondepolarizing neuromuscular blockers and polypeptide antibiotics have been demonstrated to have additive neuromuscular effects. These types of antibiotics affect both the pre-synaptic and post-synaptic myoneural area, thus acting in concert with neuromuscular blockers46523.
Why it happens (mechanism)
Decreased presynaptic release of acetylcholine and/or postjunctional blocking activity by the antibiotic
Literature reports
5 reports — tap to read
a) Concomitant pancuronium and colistin therapy has resulted in prolonged respiratory depression. This exaggerated respiratory paralysis occurred in a 55-year-old female who underwent a laparotomy using thiopental, succinylcholine, and pancuronium. The patient had previously received nine days of gentamicin therapy followed by four days of colistin sulfate 1 million units intramuscularly three times daily. Normal breathing was reinstated with 20 mL of 10% calcium gluconate approximately three hours after the last dose of pancuronium 1.
b) In a patient receiving 12 mg of tubocurarine over a 1.5-hour period, 3 mg of neostigmine plus 1.5 mg of atropine failed to cause reversal of neuromuscular blockade 2. A second dose of 1.5 mg neostigmine and 1 mg atropine was also unsuccessful. Ventilation was continued for three hours before spontaneous breathing became apparent. Following surgery, it was found that the patient had received a total of 11 grams of colistimethate in a regimen of 75 mg every eight hours.
c) In a similar report, a patient experienced neostigmine-resistant curare-reversal following a surgical procedure where 30 mg of tubocurarine was used. The patient had received 17 doses of colistin methanesulfonate (dose not stated) prior to surgery. Respiration returned following the slow administration of calcium chloride 1 gram 3.
d) One case of neuromuscular blockade recurrence following the use of vecuronium in a patient who was receiving a sternal irrigation containing polymyxin B 1 million units and amikacin 1 gram has been reported. The neuromuscular blockade was reversed with neostigmine prior to the beginning of the sternal irrigation and the patient was breathing spontaneously. However, within five minutes of the start of the polymyxin/amikacin irrigation, the patient again required controlled ventilation. The neuromuscular blockade lasted approximately four hours and the patient recovered uneventfully 4.
e) A 76-year old man experienced prolonged neuromuscular blockade following the irrigation of a surgical wound with polymyxin B 250,000 units and bacitracin 50,000 units. Pancuronium 4.8 mg had been given 35 minutes after the induction of anesthesia. Despite the administration of pyridostigmine 24.5 mg, neostigmine 1 mg, edrophonium 10 mg, and calcium chloride 1400 mg, the neuromuscular blockade persisted for 21 hours after the pancuronium dose 5.
Common questions
Can I take Rocuronium and Bacitracin Topical together?
Enhanced or prolonged neuromuscular blockade Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rocuronium and Bacitracin 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 Rocuronium or Bacitracin 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 (6)
- Giala MM & Paradelis AG: Two cases of prolonged respiratory depression due to interaction of pancuronium with colistin and streptomycin. J Antimicrob Chemother 1979; 5:234-235. PubMed
- Gebbie D: Colistimethate and curare: a case report. Anesth Analg 1971; 50:109-111. DOI
- Zauder HL, Barton N, Bennett EJ, et al: Colistimethate as a cause of postoperative apnoea. Can Anaesth Soc J 1966; 13:607-610. DOI
- Kronenfeld MA, Thomas SJ, & Turndorf H: Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation. Anesthesiology 1986; 65:93-94. PubMed
- Fogdall RP & Miller RD: Prolongation of a pancuronium-induced neuromuscular blockade by polymyxin B. Anesthesiology 1974; 40:84-87. DOI
- Lindesmith LA, Baines RD Jr, Bigelow DB, et al: Reversible respiratory paralysis associated with polymyxin therapy. Ann Intern Med 1968; 68:318-327. PubMed
Keep reading about Bacitracin Topical
Keep reading about Rocuronium
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