Amikacin interaction
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Interaction with concomitant intrathecal baclofen (first report) leading to neuromuscular blockade in an elderly patient: case report A 66-year-old man receiving intrathecal baclofen for spastic tetraplegia developed neuromuscular blockade during concomitant treatment with amikacin for Pseudomonas aeruginosa cystitis. The man, who had neurogenic bladder and often developed cystitis, had received intrathecal baclofen [dosage not stated] for 6 years. He was hospitalised with cystitis and received IV ceftazidime. A urine culture detected multiresistant P. aeruginosa. It was decided to administer IV amikacin at a dosage of 500mg every 12 hours; this treatment regimen was modified to a single daily infusion of 1g to accommodate treatment at home. He was admitted to a centre and received his first dose of IV amikacin over 30 minutes. After 10–15 minutes, it was noted that his muscle tone and strength had deteriorated to 0/5 in his right limbs (1–2 at admission to the centre) and 1/5 in his left limbs (3–4 at admission). He was unable to stand. Amikacin was discontinued. Subsequently, the man recovered spontaneously. Within about 36 hours, he regained his previous neurological status. Author comment: A Naranjo score of 7 was calculated for the adverse reaction in this patient. We believe that a pharmacodynamic interaction occurred between intrathecal baclofen and intravenous amikacin, which had synergistic effects that enhanced the muscle-relaxant effect of baclofen. Fern´andez-Miera MF, et al. Neuromuscular blockade due to intravenous amikacine and intrathecal baclofen. Medicina Clinica 126: 679, No. 17, 6 May 2006 [Spanish; 801043509 summarised from an English translation] - Spain
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of an interaction between amikacin and baclofen. The WHO Adverse Drug Reactions database contained 11 reports involving the concomitant use of amikacin and baclofen.
0114-9954/10/1119-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 16 Sep 2006 No. 1119
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