Interaction Checker

OnabotulinumtoxinA interactions

OnabotulinumtoxinA (Botox), a neuromuscular blocker has 57 documented interactions across the FDA labels and fact sheets we index: 3 major, 47 moderate, 6 minor, and 1 where a label reports no significant interaction. Each entry below quotes the sentence behind it. This drug page is a starting point, not a verdict for your situation.

Major interactions (3)

  • Lidocainelocal anestheticMajor

    One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent, and consequently the causal agent cannot be reliably determined. (OnabotulinumtoxinA label, Warnings and precautions)

  • Lidocaine and prilocainelocal anestheticMajor

    One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent, and consequently the causal agent cannot be reliably determined. (OnabotulinumtoxinA label, Warnings and precautions)

  • NeomycinaminoglycosideMajor

    The possibility of the occurrence of neuromuscular blockage and respiratory paralysis should be considered if neomycin is administered, especially to patients receiving anesthetics, neuromuscular blocking agents such as tubocurarine, succinylcholine, decamethonium, or in patients receiving massive transfusions of citrate anticoagulated blood. (Neomycin label, Boxed warning)

Moderate interactions (47)

  • AclidiniumanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • AmantadineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Amitriptylinetricyclic antidepressantModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Baclofenmuscle relaxantModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • BenztropineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Carisoprodolmuscle relaxantModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • ChlorpheniramineantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • ChlorpromazineantipsychoticModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • ClindamycinantibioticModerate

    • Neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. (Clindamycin label, Drug interactions)

  • ClozapineantipsychoticModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Cyclobenzaprinemuscle relaxantModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • CyclopentolateanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Dantrolenemuscle relaxantModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • DarifenacinanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • DicyclomineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • DimenhydrinateantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • DiphenhydramineantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Doxepintricyclic antidepressantModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • DoxylamineantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • FentanylopioidModerate

    • Risks of Skeletal Muscle Rigidity and Skeletal Muscle Movement : Manage with neuromuscular blocking agent. (Fentanyl label, Warnings and precautions)

  • FesoterodineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • GentamicinaminoglycosideModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • GlycopyrrolateanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • HydroxyzineantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • HyoscyamineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • IpratropiumanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Lithiumserotonergic drugModerate

    Neuromuscular Blocking Agents Clinical Impact: Lithium may prolong the effects of neuromuscular blocking agents. (Lithium label, Drug interactions)

  • MeclizineantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Methocarbamolmuscle relaxantModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • Nifedipinedihydropyridine calcium channel blockerModerate

    …diverticulosis, and inflammatory bowel disease), hypomotility disorders (e.g., constipation, gastroesophageal reflux disease, ileus, obesity, hypothyroidism, and diabetes) and concomitant medications (e.g., H 2 -histamine blockers, opiates, nonsteroidal anti-inflammatory drugs, laxatives, anticholinergic agents, levothyroxine, and neuromuscular blocking agents). (Nifedipine label, Warnings)

  • Nortriptylinetricyclic antidepressantModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • OlanzapineantipsychoticModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • OxybutyninanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • ParoxetineSSRIModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • ProchlorperazineantipsychoticModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • PromethazineantihistamineModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Pyridostigminecholinesterase inhibitorModerate

    Depolarizing neuromuscular blocking agents: Increased effect. (Pyridostigmine label, Drug interactions)

  • ScopolamineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • SolifenacinanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • TiotropiumanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Tizanidinemuscle relaxantModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • TobramycinaminoglycosideModerate

    Patients receiving concomitant treatment of BOTOX and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like agents), or muscle relaxants, should be observed closely because the effect of BOTOX may be potentiated ( 7.1 , 7.4 ) (OnabotulinumtoxinA label, Drug interactions)

  • TolterodineanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • TrihexyphenidylanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • TrospiumanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Umeclidinium and vilanterolanticholinergicModerate

    Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

  • Verapamilcalcium channel blockerModerate

    Neuromuscular Blocking Agents Clinical data and animal studies suggest that verapamil may potentiate the activity of neuromuscular blocking agents (curare-like and depolarizing). (Verapamil label, Drug interactions)

Minor mentions (6)

  • CarbamazepineanticonvulsantMinor

    N e uromuscular Blocking Agents Resistance to the neuromuscular blocking action of the nondepolarizing neuromuscular blocking agents pancuronium, vecuronium, rocuronium and cisatracurium has occurred in patients chronically administered carbamazepine. (Carbamazepine label, Drug interactions)

  • Digoxindigitalis glycosideMinor

    Norepinephrine Dopamine Neuromuscular Blocking Agents Succinylcholine May cause sudden extrusion of potassium from muscle cells causing arrhythmias in patients taking digoxin. (Digoxin label, Drug interactions)

  • Donepezilcholinesterase inhibitorMinor

    A synergistic effect may be expected with concomitant administration of succinylcholine, similar neuromuscular blocking agents, or cholinergic agonists ( 7.2 ) (Donepezil label, Drug interactions)

  • Galantaminecholinesterase inhibitorMinor

    Anesthesia Galantamine, as a cholinesterase inhibitor, is likely to exaggerate the neuromuscular blocking effects of succinylcholine-type and similar neuromuscular blocking agents during anesthesia. (Galantamine label, Warnings and precautions)

  • PhenytoinanticonvulsantMinor

    Neuromuscular blocking agents Cisatracurium, pancuronium, rocuronium and vecuronium: resistance to the neuromuscular blocking action of the nondepolarizing neuromuscular blocking agents has occurred in patients chronically administered phenytoin. (Phenytoin label, Drug interactions)

  • PropofolCNS depressantMinor

    Common Neuromuscular Blocking Agents DIPRIVAN does not cause a clinically significant change in onset, intensity or duration of action of the commonly used neuromuscular blocking agents (e.g., succinylcholine and nondepolarizing muscle relaxants). (Propofol label, Drug interactions)

No significant interaction reported (1)

  • Dexmedetomidinealpha-adrenergic agonistNo interaction

    Neuromuscular Blockers In one study of 10 healthy adult volunteers, administration of dexmedetomidine for 45 minutes at a plasma concentration of one ng/mL resulted in no clinically meaningful increases in the magnitude of neuromuscular blockade associated with rocuronium administration. (Dexmedetomidine label, Drug interactions)

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Not medical advice. Severity reflects the label's wording, not your circumstances. A "major" flag can be routine under supervision and a "minor" one can matter at high doses. Ask a pharmacist.