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Review
Antiepileptic-induced resistance to neuromuscular blockers: mechanisms and clinical significance.
- Sulpicio G Soriano and J A Jeevendra Martyn.
- Harvard Medical School and Children's Hospital, Boston, Massachusetts 02115, USA. sulpicio.soriano@tch.harvard.edu
- Clin Pharmacokinet. 2004 Jan 1; 43 (2): 71-81.
AbstractProlonged administration of antiepileptic drugs is associated with several drug interactions. In the field of anaesthesia and critical care, patients exhibit both sensitivity and resistance to non-depolarising neuromuscular blockers (NDNMBs) after acute and long-term administration of antiepileptic drugs, respectively. Although antiepileptic therapy alone has only mild neuromuscular effects, acutely administered antiepileptic drugs can potentiate the neuromuscular effects of NDNMBs as a result of direct pre- and post-junctional effects. Resistance to NDNMBs during long-term antiepileptic therapy is due to multiple factors operating alone or in combination, including induction of hepatic drug metabolism, increased protein binding of the NDNMBs and/or upregulation of acetylcholine receptors.
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