Skip to main content

Drug Interactions between articaine / epinephrine and vecuronium

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

vecuronium articaine

Applies to: vecuronium and articaine / epinephrine

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

Drug and food interactions

Moderate

EPINEPHrine food

Applies to: articaine / epinephrine

Consumer information for this interaction is not currently available.

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer