Rocuronium and Clindamycin: 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
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.
These two medicines are usually used together only in a hospital setting. Rocuronium is a medicine given during surgery to relax your muscles so you can be safely put on a breathing machine. Clindamycin is an antibiotic. When they are used together, clindamycin can make the muscle-relaxing effect of rocuronium stronger and last longer, especially at higher antibiotic doses.
The good news is that this happens in a closely watched setting. Your anesthesia and surgical team can adjust the rocuronium dose and keep you on breathing support until the effect fully wears off. This is a well-understood situation your care team knows how to manage.
Effect: Enhanced and prolonged neuromuscular blockade with concurrent clindamycin and rocuronium (a nondepolarizing agent).
Mechanism: Additive/synergistic; clindamycin acts at pre- and postsynaptic sites and directly on muscle contractility, augmenting the blockade. Neither agent is enzymatically activated in a way that alters this PD interaction.
Direction: Increased and prolonged rocuronium effect, dose-related with clindamycin.
- Onset: rapid
- Evidence: theoretical
- Management: monitor depth of block (train-of-four), consider reducing rocuronium dose, anticipate need for prolonged respiratory support and recovery monitoring.
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, an effect that becomes more pronounced at higher clindamycin doses1234. Clindamycin's contribution to this effect may involve activity at both presynaptic and postsynaptic sites, along with a direct influence on the contractility of muscle.
Why it happens (mechanism)
Additive effects
How to manage this interaction
This interaction is managed by your hospital care team, so the main thing you need to do is make sure they have your full medication list, including any clindamycin.
- Your anesthesia team may lower the rocuronium dose and tailor it to you.
- They will monitor your muscle response closely during and after surgery.
- They will be ready to provide breathing support until the muscle relaxant fully wears off.
Keep taking any prescribed antibiotic as directed, and tell your surgical team and pharmacist about all your medications before any procedure.
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 plus 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, since 600 mg had been prescribed. Following surgery, the patient made no efforts at spontaneous breathing 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 recovered to 1.0. Two hours afterward, she was extubated and spontaneous respiration began. The authors proposed that clindamycin produced muscle relaxation mainly through a direct effect on contractility, though some pre-synaptic effects were also considered to occur 1.
Common questions
Can I take Rocuronium and Clindamycin together?
Clindamycin can strengthen and prolong rocuronium's muscle-relaxing effect, so your anesthesia team may use a lower rocuronium dose, monitor you closely, and be ready with breathing support. This is routinely managed in the hospital. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rocuronium and Clindamycin 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 Rocuronium and Clindamycin interaction managed?
This interaction is managed by your hospital care team, so the main thing you need to do is make sure they have your full medication list, including any clindamycin. Your anesthesia team may lower the rocuronium dose and tailor it to you. They will monitor your muscle response closely during and after surgery. They will be ready to provide breathing support until the muscle relaxant fully wears of… 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 Rocuronium or Clindamycin 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 Rocuronium
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