Q; 58 year old male with history of seizure is admitted to ICU with aspiration pneumonia requiring mechanical ventilation along with sedation and neuro-muscular blockade (NMB). Despite high dose of Nimbex (Cisatracurium) adequate NMB cannot be achieved. Which anti-seizure medicine may be interacting here?
Carbamazepine not only increases the clearance of cisatracurium, but also increases the resistance to the neuromuscular blocking effect of cisatracurium. Higher doses of cisatracurium may be required in patients on chronic carbamazepine therapy.