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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)

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

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Minor

succinylcholine SUFentanil

Applies to: Anectine (succinylcholine) and bupivacaine / sufentanil

Sufentanil, when combined with neuromuscular blocking agents during surgical procedures, may adversely effect cardiovascular function. Tachycardia, bradycardia, and/or hypotension may result. However, muscle relaxants and sufentanil frequently are used together during surgery. Patients should be closely monitored for clinically significant alterations in hemodynamics.

References

  1. Thomson IR, MacAdams CL, Hudson RJ, Rosenbloom M "Drug interactions with sufentanil: hemodynamic effects of premedication and muscle relaxants." Anesthesiology 76 (1992): 922-9
  2. Clotz MA, Nahata MC "Clinical uses of fentanyl, sufentanil, and alfentanil." Clin Pharm 10 (1991): 581-93
  3. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals PROD (2001):

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Drug and food interactions

Moderate

SUFentanil food

Applies to: bupivacaine / sufentanil

GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References

  1. Linnoila M, Hakkinen S "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther 15 (1974): 368-73
  2. Sturner WQ, Garriott JC "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA 223 (1973): 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol 41 (1991): 147-52
  4. Levine B, Saady J, Fierro M, Valentour J "A hydromorphone and ethanol fatality." J Forensic Sci 29 (1984): 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol 19 (1985): 398-401
  6. Carson DJ "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet 1 (1977): 894-7
  7. Rosser WW "The interaction of propoxyphene with other drugs." Can Med Assoc J 122 (1980): 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM "Distalgesic and ethanol-impaired function." Lancet 2 (1982): 384
  9. Kiplinger GF, Sokol G, Rodda BE "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther 212 (1974): 175-80
View all 9 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.

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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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