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Drug Interactions between levobunolol ophthalmic and Xaracoll

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

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Interactions between your drugs

Moderate

BUPivacaine levobunolol ophthalmic

Applies to: Xaracoll (bupivacaine) and levobunolol ophthalmic

MONITOR: Beta-blockers may increase the risk of bupivacaine-induced side effects. The proposed mechanism is increased bupivacaine levels due to hepatic enzyme inhibition (propranolol) and/or additive negative inotropic effects on the heart. Patients with heart failure may be at a greater risk. Data have been conflicting and variable. Theoretically, beta-blocker ophthalmic solutions may also interact, as they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

MANAGEMENT: Caution is recommended if multiple doses of bupivacaine are administered in the presence of a beta-blocker. Monitoring for drowsiness, mental status changes, convulsions, ECG changes, and hypotension is advisable during concurrent therapy.

References

  1. Roitman K, Sprung J, Wallace M, Matjasko J (1993) "Enhancement of bupivacaine cardiotoxcity with cardiac glycosides and beta-adrenergic blockers: a case report." Anesth Analg, 76, p. 658-61
  2. Ponten J, Biber B, Bjuro T, Henriksson BA, Hjalmarson A, Lundberg D (1982) "Beta-receptor blockade and spinal anaesthesia. Withdrawal versus continuation of long-term therapy." Acta Anaesthesiol Scand Suppl, 76, p. 62-9
  3. Ponten J, Biber B, Henriksson BA, Jonsteg C (1982) "Bupivacaine for intercostal nerve blockade in patients on long-term beta-receptor blocking therapy." Acta Anaesthesiol Scand Suppl, 76, p. 70-7

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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.

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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