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Drug Interactions between Epi EZ Pen and Ultane

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

EPINEPHrine sevoflurane

Applies to: Epi EZ Pen (epinephrine) and Ultane (sevoflurane)

GENERALLY AVOID: Rarely, the combination of epinephrine and some anesthetics has resulted in ventricular irritability, serious cardiac arrhythmias, or death. The halogenated anesthetics sensitize the heart to the arrhythmogenic effects of catecholamines.

MANAGEMENT: This combination should be avoided or used very cautiously. If a halogenated anesthetic and epinephrine must be used together, an epinephrine concentration of 1:100,000 or 1:200,000 is recommended. The adult dosage should not exceed 100 mcg of a 1:100,000 solution in any 10-minute period. The patient's hemodynamic status should be closely monitored. Lidocaine has a protective effect against the arrhythmogenic potential of epinephrine. Topical epinephrine appears to be relatively safe for use during anesthesia.

References

  1. Ueda W, Hirakawa M, Mae O "Appraisal of epinephrine administration to patients under halothane anesthesia for closure of cleft palate." Anesthesiology 58 (1983): 574-6
  2. Ghoneim MM "Drug interaction in anaesthesia. A review." Can Anaesth Soc J 18 (1971): 353-75
  3. Cullen BF, Miller MG "Drug interactions and anesthesia: a review." Anesth Analg 58 (1979): 413-23
  4. Cooke JE "Drug interactions in anesthesia." Clin Plast Surg 12 (1985): 83-9
  5. Forbes AM "Halothane, adrenaline and cardiac arrest." Anaesthesia 21 (1966): 22-7
  6. Kainuma M, Suzuki A "Convulsions after adrenaline administration during enflurane anaesthesia." Anaesthesia 41 (1986): 874-5
  7. Horrigan RW, Eger EI, Wilson C "Epinephrine-induced arrhythmias during enflurane anesthesia in man: a nonlinear dose-response relationship and dose-dependent protection from lidocaine." Anesth Analg 57 (1978): 547-50
  8. Reisner LS, Lippmann M "Further data on epinephrine interactions." Anesth Analg 56 (1977): 468
  9. Johnston RR, Eger EI II, Wilson C "A comparative interaction of epinephrine with enflurane, isoflurane, and halothane in man." Anesth Analg 55 (1976): 709-12
  10. Reisner LS, Lippmann M "Ventricular arrhythmias after epinephrine injection in enflurane and in halothane anesthesia." Anesth Analg 54 (1975): 468-70
  11. Snow JC, Shamsai J, Sakarya I "Effects of epinephrine during halothane anesthesia in mastoidotympanoplastic surgery." Anesth Analg 47 (1968): 252-6
  12. Karl HW, Swedlow DB, Lee KW, Downes JJ "Epinephrine-halothane interactions in children." Anesthesiology 58 (1983): 142-5
  13. Mostello L, Stueber K, Lake CR "Is topical application of epinephrine at skin graft donor sites during halothane anesthesia safe?" Ann Plast Surg 20 (1988): 313-6
  14. Hirshom WI, Taylor RG, Sheehan JC "Arrhythmias produced by combinations of halothane and small amounts of vasopressor." Br J Oral Surg 2 (1964): 131-6
  15. Bennett JA, Eltringham RJ "Possible dangers of anaesthesia in patients receiving fenfluramine. Results of animal studies following a case of human cardiac arrest." Anaesthesia 32 (1977): 8-13
  16. Konchigeri HN, Shaker MH, Winnie AP "Effect of epinephrine during enflurane anesthesia." Anesth Analg 53 (1974): 894-7
  17. Pepple J "Epinephrine-halothane interaction in children versus adults." Anesthesiology 60 (1984): 76-8
  18. Smith RB "Drug interactions and drug reactions." Otolaryngol Clin North Am 14 (1981): 615-29
  19. "Product Information. Ultane (sevoflurane)." Abbott Pharmaceutical PROD (2001):
  20. "Product Information. Fluothane (halothane)." Wyeth-Ayerst Laboratories PROD (2001):
View all 20 references

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Drug and food interactions

Moderate

EPINEPHrine food

Applies to: Epi EZ Pen (epinephrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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