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Drug Interactions between Anectine and bupivacaine / sufentanil

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

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Interactions between your drugs

Moderate

BUPivacaine succinylcholine

Applies to: bupivacaine / sufentanil and Anectine (succinylcholine)

Consumer information for this interaction is not currently available.

MONITOR: Neuromuscular-blocking effects may be potentiated when neuromuscular blocking agents are coadministered with local anesthetics, however, the mechanism is not completely understood. In one study of 10 healthy volunteers evaluating the use of regional anesthesia with intravenous prilocaine with (n=5) or without mivacurium (n=5), prolonged weakness was observed in subjects who received both prilocaine and mivacurium, compared to the control group. Another study of patients undergoing orthognathic surgery (n=16) evaluated the degree of neuromuscular blockade using the train of four (TOF) prior to induction and during maintenance anesthesia with propofol, fentanyl and rocuronium, with or without an oral mucosal injection of lidocaine 1% with epinephrine 10 mcg/mL (LE). The TOF ratio began to decrease 2 minutes after the injection of LE, reached a minimum value of approximately 3% twelve minutes after the injection, and then began to recover, indicating an increase in neuromuscular blockade when LE was administered with rocuronium compared to the control group. In another study of healthy patients (n=30), the effect of epidural bupivacaine on the duration, intensity, and reversal of atracurium-induced neuromuscular muscular blockade was evaluated. In the epidural bupivacaine group (n=15), the duration of neuromuscular blockade, time until first response to TOF, and reversal time were all significantly prolonged when compared to the control group. Clinical data for all neuromuscular blocking agents and local anesthetics are lacking.

MANAGEMENT: Monitoring for prolonged and/or enhanced neuromuscular blockade is advised if local anesthetics are coadministered with neuromuscular-blocking agents. Individual product labeling for the neuromuscular blocking agent should be consulted for specific recommendations and guidance.

References

  1. Pouttu J, Tuominen MK, Rosenberg PH "Cardiovascular responses caused by the combination of lidocaine and vecuronium in the induction of general anaesthesia." Acta Anaesthesiol Scand 32 (1988): 549-52
  2. Fukuda S, Wakuta K, Ishikawa T, Oshita S, Sakabe T, Takeshita H "Lidocaine modifies the effect of succinylcholine on muscle oxygen consumption in dogs." Anesth Analg 66 (1987): 325-8
  3. Matsuo S, Rao DBS, Chaudry I, Foldes FF "Interaction of muscle relaxants and local anesthetics at the neuromuscular junction." Anesth Analg 57 (1978): 580-7
  4. Bruckner J, Thomas KC, Bikhazi GB, Foldes FF "Neuromuscular drug interactions of clinical importance." Anesth Analg 59 (1980): 678-82
  5. Harrah MD, Way WL, Katzung BG "The interaction of d-tubocurarine with antiarrhythmic drugs." Anesthesiology 33 (1970): 406-10
  6. Miller RD, Way WL "Inhibition of succinylcholine-induced increased intragastric pressure by nondepolarizing muscle relaxants and lidocaine." Anesthesiology 34 (1971): 185-8
  7. "Product Information. Rocuronium Bromide (rocuronium)." Hospira Inc (2019):
  8. "Product Information. Anectine (succinylcholine)." Sandoz Inc (2022):
  9. "Product Information. Lidocaine Hydrochloride (lidocaine)." Hospira Inc. (2024):
  10. "Product Information. Lidocaine Hydrochloride (lidocaine)." Hospira Healthcare Corporation (2015):
  11. "Product Information. Lidocaine Hydrochloride (lidocaine)." Hameln Pharma Ltd (2022):
  12. "Product Information. Xylocaine HCl (lidocaine)." Aspen Pharmacare Australia Pty Ltd (2022):
  13. Ninomiya A, Terakawa Y, Matsuura N, Ichinohe T, Kaneko Y "Oral mucosal injection of a local anesthetic solution containing epinephrine enhances muscle relaxant effects of rocuronium https://pubmed.ncbi.nlm.nih.gov/22428970/" (2024):
  14. Torrance JM, lewer bm, Galletly DC "Low-dose mivacurium supplementation of prilocaine i.v. regional anaesthesia https://pubmed.ncbi.nlm.nih.gov/9068344/" (2024):
  15. toft p, nielsen hk, severinsen i, Helbo-Hanson HS "Effect of epidurally administered bupivacaine on atracurium-induced neuromuscular blockade https://pubmed.ncbi.nlm.nih.gov/2275325/" (2024):
  16. "Product Information. Cisatracurium Besylate (cisatracurium)." Hikma Pharmaceuticals USA Inc. (2023):
View all 16 references
Minor

succinylcholine SUFentanil

Applies to: Anectine (succinylcholine) and bupivacaine / sufentanil

Information for this minor interaction is available on the professional version.

Drug and food interactions

Moderate

SUFentanil food

Applies to: bupivacaine / sufentanil

Do not use alcohol or medications that contain alcohol while you are receiving treatment with SUFentanil. This may increase nervous system side effects such as drowsiness, dizziness, lightheadedness, difficulty concentrating, and impairment in thinking and judgment. In severe cases, low blood pressure, respiratory distress, fainting, coma, or even death may occur. With certain long-acting formulations of narcotic pain medication, consumption of alcohol may also cause rapid release of the drug, resulting in high blood levels that may be potentially lethal. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. Do not use more than the recommended dose of SUFentanil, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

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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

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

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