Drug Interactions between nitrous oxide and Xaracoll
This report displays the potential drug interactions for the following 2 drugs:
- nitrous oxide
- Xaracoll (bupivacaine)
Interactions between your drugs
BUPivacaine nitrous oxide
Applies to: Xaracoll (bupivacaine) and nitrous oxide
MONITOR CLOSELY: Coadministration of local anesthetics with other oxidizing agents that can also induce methemoglobinemia such as other local anesthetics, antimalarials (e.g., primaquine, tafenoquine), nitrates and nitrites, dapsone, flutamide, and rasburicase, may increase the risk. Additional risk factors include very young age (e.g., infants less than 6 months), cardiac or pulmonary disease, genetic predisposition, and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
MANAGEMENT: Close monitoring for signs and symptoms of methemoglobinemia is recommended if local anesthetics must be used with other methemoglobin-inducing agents. Signs and symptoms of methemoglobinemia may occur immediately or hours after drug exposure. Patients or their caregivers should be advised to seek medical attention if they notice signs and symptoms of methemoglobinemia (e.g., cyanotic skin discoloration, abnormal blood coloration, nausea, headache, dizziness, lightheadedness, lethargy, fatigue, dyspnea, tachypnea, tachycardia, palpitation, anxiety, and confusion). In severe cases, patients may progress to central nervous system depression, stupor, seizures, acidosis, cardiac arrhythmias, syncope, shock, coma, and death. Methemoglobinemia should be considered if central cyanosis is unresponsive to oxygen. Calculated oxygen saturation and pulse oximetry are generally not accurate in the setting of methemoglobinemia. The diagnosis can be confirmed by an elevated methemoglobin level of at least 10% using co-oximetry. Methemoglobin concentrations greater than 10% of total hemoglobin will typically cause cyanosis, and levels over 70% are frequently fatal. However, symptom severity is not always related to methemoglobin levels. Experts suggest that treatment of methemoglobinemia varies from supplemental oxygen and symptom support to the administration of methylene blue, depending on severity of symptoms and/or the presence of G6PD deficiency. Institutional guidelines and/or individual product labeling should be consulted for further guidance.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2008) "Product Information. Marcaine HCl (bupivacaine)." Hospira Inc
- Guay J (2009) "Methemoglobinemia related to local anesthetics: a summary of 242 episodes." Anesth Analg, 108, p. 837-45
- Skold A, Cosco DL, Klein R (2011) "Methemoglobinemia: pathogenesis, diagnosis, and management." South Med J, 104, p. 757-61
- (2021) "Product Information. Zynrelef (bupivacaine-meloxicam)." Heron Therapeutics
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.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
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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