title: Antiepileptic-induced resistance to neuromuscular blockers: mechanisms and clinical significance.
abstract: Prolonged 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.
authors.affiliation: Harvard Medical School and Children's Hospital, Boston, Massachusetts 02115, USA. sulpicio.soriano@tch.harvard.edu
authors.forename: Sulpicio G
authors.initials: SG
authors.lastname: Soriano
authors.forename: J A Jeevendra
authors.initials: JA
authors.lastname: Martyn
mesh_terms: D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000493:pharmacokinetics / Q000494:pharmacology*; D011950:Receptors, Cholinergic / Q000187:drug effects*
chemical_list: D000927:Anticonvulsants; D003473:Neuromuscular Nondepolarizing Agents; D011950:Receptors, Cholinergic