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Xylocaine-MPF-Epinephrine (epinephrine / lidocaine) Disease Interactions

There are 10 disease interactions with Xylocaine-MPF-Epinephrine (epinephrine / lidocaine):

Major

Antiarrhythmics (Includes Xylocaine-MPF-Epinephrine) ↔ Cardiovascular Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure, Hypotension

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
  2. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
  3. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 17 references
Major

Antiarrhythmics (Includes Xylocaine-MPF-Epinephrine) ↔ Proarrhythmic Effects

Severe Potential Hazard, High plausibility

Applies to: Arrhythmias

Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.

References

  1. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  2. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  3. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
View all 62 references
Major

Lidocaine (Includes Xylocaine-MPF-Epinephrine) ↔ Hepatic Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.

References

  1. Thomson AH, Elliott HL, Kelman AW, et al "The pharmacokinetics and pharmacodynamics of lignocaine and MEGX in healthy subjects." J Pharmacokinet Biopharm 15 (1987): 101-15
  2. Huang YS, Lee SD, Deng JF, Wu JC, Lu RH, Lin YF, Wang YJ, Lo KJ "Measuring lidocaine metabolite - monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis." J Hepatol 19 (1993): 140-7
  3. Huet P-M, LeLorier J "Effects of smoking and chronic hepatitis B on lidocaine and indocyanine green kinetics." Clin Pharmacol Ther 28 (1980): 208-15
View all 13 references
Major

Lidocaine (Includes Xylocaine-MPF-Epinephrine) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.

References

  1. Collinsworth KA, Strong JM, Atkinson AJ Jr, et al "Pharmacokinetics and metabolism of lidocaine in patients with renal failure." Clin Pharmacol Ther 18 (1975): 59-64
  2. Jacobi J, McGory RW, McCoy H, Matzke GR "Hemodialysis clearance of total and unbound lidocaine." Clin Pharm 2 (1983): 54-7
  3. Thomson PD, Rowland M, Melmon KL "The influence of heart failure, liver disease, and renal failure on the disposition of lidocaine in man." Am Heart J 82 (1971): 417-21
View all 8 references
Major

Lidocaine (Includes Xylocaine-MPF-Epinephrine) ↔ Seizures

Severe Potential Hazard, High plausibility

Applies to: Seizures

Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.

References

  1. Wu FL, Razzaghi A, Souney PF "Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia." Pharmacotherapy 13 (1993): 72-8
  2. Crampton RS, Oriscello RG "Petit and grand mal convulsions during lidocaine hydrochloride treatment of ventricular tachycardia." JAMA 204 (1968): 109-12
  3. Fortuna A, Fortuna AO "Convulsion during lignocaine infiltration." Anaesth Intensive Care 21 (1993): 483
View all 7 references
Major

Lidocaine (Includes Xylocaine-MPF-Epinephrine) ↔ Sinus/Av Node Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Heart Block

The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.

References

  1. Keidar S, Grenadier E, Palant A "Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration." Am Heart J 104 (1982): 1384-5
  2. Tagliente TM, Jayagopal S "Transient left bundle branch block following lidocaine." Anesth Analg 69 (1989): 545-7
  3. Hilleman DE, Mohiuddin SM, Destache CJ "Lidocaine-induced second-degree mobitz type II heart block." Drug Intell Clin Pharm 19 (1985): 669-73
View all 4 references
Major

Sympathomimetics (Includes Xylocaine-MPF-Epinephrine) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: Hypertension, Hyperthyroidism, Cardiovascular Disease, Cerebrovascular Insufficiency, Pheochromocytoma

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

References

  1. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
  2. Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ "Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations." Lancet 1 (1980): 60-1
  3. Gordon RD, Ballantine DM, Bachmann AW "Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma." Clin Exp Pharmacol Physiol 19 (1992): 287-90
View all 56 references
Moderate

Antiarrhythmics (Includes Xylocaine-MPF-Epinephrine) ↔ Electrolyte Imbalance

Moderate Potential Hazard, High plausibility

Applies to: Hypokalemia, Hyperkalemia, Magnesium Imbalance

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsades de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

References

  1. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  3. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 13 references
Moderate

Epinephrine (Includes Xylocaine-MPF-Epinephrine) ↔ Parkinson's Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Parkinsonism, Neurologic Disorder

Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.

Moderate

Sympathomimetics (Includes Xylocaine-MPF-Epinephrine) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Covington TR, Lawson LC, Young LL, eds. "Handbook of Nonprescription Drugs. 10th ed." Washington, DC: American Pharmaceutical Association (1993):
View all 4 references

Xylocaine-MPF-Epinephrine (epinephrine / lidocaine) drug Interactions

There are 523 drug interactions with Xylocaine-MPF-Epinephrine (epinephrine / lidocaine)

Xylocaine-MPF-Epinephrine (epinephrine / lidocaine) alcohol/food Interactions

There is 1 alcohol/food interaction with Xylocaine-MPF-Epinephrine (epinephrine / lidocaine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

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.

Do not stop taking any medications without consulting your healthcare provider.

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