Can you take Benzethonium chloride / lidocaine topical with Quinine?
1 drug interaction and 18 additional warnings found for the following 2 drugs:
- benzethonium chloride/lidocaine topical
- quinine
Drug interactions
Moderate drug interactions
Moderate:
quiNINE lidocaine topical
Applies to: quinine and benzethonium chloride / lidocaine topical
Some of the medication in lidocaine topical may be absorbed into the bloodstream following local application. When present in sufficient concentrations in the blood, local anesthetics such as lidocaine topical may cause methemoglobinemia, a rare condition that can lead to oxygen deprivation in tissues and vital organs due to reduced oxygen-carrying capacity of the blood. The risk is increased when combined with other medications that can also induce methemoglobinemia such as quiNINE. Individuals may be more susceptible to developing methemoglobinemia during treatment with these medications if they are very young (especially neonates and infants) or have anemia, diseases of the heart or lungs, blood circulation disorders, liver cirrhosis, shock, sepsis, and certain genetic predispositions such as NADH cytochrome-b5 reductase deficiency, glucose-6-phosphate dehydrogenase deficiency, and hemoglobin M. In addition, use of topical anesthetics on inflamed or abraded areas or broken skin, as well as excessive use such as application of large doses or on larger than recommended areas, can increase absorption and result in high blood levels of the medication. Topical anesthetics that are applied to mucous membranes such as inside the mouth, nose, or throat (e.G., for sore throat; for numbing prior to dental procedures or scoping of the lungs or gastrointestinal tract) may also be absorbed to a significant extent. Close medical supervision is necessary when medications that can cause methemoglobinemia are used together. Do not exceed the recommended dose or frequency and duration of use when treated with products that contain local anesthetics, including some over-the-counter preparations. Signs and symptoms of methemoglobinemia may be delayed by several hours after treatment with topical anesthetics. Patients (or their caregivers) should seek immediate medical attention if they develop a gray discoloration of the skin, mouth, or nail bed; nausea; headache; dizziness; lightheadedness; fatigue; shortness of breath; rapid or shallow breathing; a rapid heartbeat; palpitation; anxiety; or confusion. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Food/lifestyle interactions
Minor food/lifestyle interactions
Minor:
quiNINE Food/Lifestyle
Applies to: quinine
Information for this minor interaction is available on the professional version.
Minor:
lidocaine topical Food/Lifestyle
Applies to: benzethonium chloride / lidocaine topical
Information for this minor interaction is available on the professional version.
Disease interactions
16 potential interactions Applies to: 14 conditions, including Seizures, Arrhythmia, Hypokalemia, Myasthenia Gravis, and Tinnitus.
Arrhythmia
Major:
quinine
quiNINE has a major potential interaction with Arrhythmia.
The use of certain antimalarial agents is contraindicated in patients with known prolongation of QT interval as these patients can develop fatal arrhythmias. These drugs should also be avoided in patients with clinical conditions known to prolong the QT interval, such as uncorrected hypokalemia or hypomagnesemia, bradycardia, and certain other cardiac conditions. Caution is advised in patients taking other medications that can prolong the QT interval.
G-6-PD Deficiency
Major:
quinine
quiNINE has a major potential interaction with G-6-PD Deficiency.
The use of quinine is contraindicated in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Red blood cells are more easily destroyed in patients with G-6-PD deficiency and may lead to hemolysis and anemia.
Heart Block
Major:
benzethonium chloride / lidocaine topical
The lidocaine topical in benzethonium chloride / lidocaine topical has a major potential interaction with Heart Block.
Lidocaine is absorbed through intact skin and mucosal membranes following topical administration. Prolonged exposure, large doses, frequent applications and/or use on compromised skin or mucosa can produce systemic effects. At high plasma levels, lidocaine can cause hypotension, bradycardia, and cardiovascular collapse. Therapy with lidocaine topical should be administered cautiously in patients with shock, sinus bradyarrhythmia, or severe heart block. The recommended dosage should not be exceeded. Children and debilitated, elderly, or acutely ill patients should be given reduced dosages commensurate with their age, weight, and physical condition.
Hypokalemia
Major:
quinine
quiNINE has a major potential interaction with Hypokalemia.
The use of certain antimalarial agents is contraindicated in patients with known prolongation of QT interval as these patients can develop fatal arrhythmias. These drugs should also be avoided in patients with clinical conditions known to prolong the QT interval, such as uncorrected hypokalemia or hypomagnesemia, bradycardia, and certain other cardiac conditions. Caution is advised in patients taking other medications that can prolong the QT interval.
Liver Disease
Major:
benzethonium chloride / lidocaine topical
The lidocaine topical in benzethonium chloride / lidocaine topical has a major potential interaction with Liver Disease.
Lidocaine topical is absorbed through intact skin and mucosal membranes. Prolonged exposure, large doses, and/or application to compromised skin or mucosa can result in elevated plasma concentrations of lidocaine. 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. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine topical should be administered cautiously and dosing modified for patients with compromised hepatic function.
Moderate:
quinine
quiNINE has a moderate potential interaction with Liver Disease.
In patients with severe hepatic impairment (Child-Pugh C), quinine oral clearance is decreased, volume of distribution is increased, and half-life is prolonged, relative to subjects with normal liver function. Therefore, quinine is not indicated in patients with severe hepatic impairment and alternate therapy should be administered. Adjustment of the recommended dose is not required in mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment, but patients should be monitored closely for adverse effects of quinine.
Magnesium Imbalance
Major:
quinine
quiNINE has a major potential interaction with Magnesium Imbalance.
The use of certain antimalarial agents is contraindicated in patients with known prolongation of QT interval as these patients can develop fatal arrhythmias. These drugs should also be avoided in patients with clinical conditions known to prolong the QT interval, such as uncorrected hypokalemia or hypomagnesemia, bradycardia, and certain other cardiac conditions. Caution is advised in patients taking other medications that can prolong the QT interval.
Myasthenia Gravis
Major:
quinine
quiNINE has a major potential interaction with Myasthenia Gravis.
The use of quinine is contraindicated in patients with myasthenia gravis, as quinine has neuromuscular blocking activity, and may exacerbate muscle weakness.
Renal Dysfunction
Major:
benzethonium chloride / lidocaine topical
The lidocaine topical in benzethonium chloride / lidocaine topical has a major potential interaction with Renal Dysfunction.
Lidocaine topical is absorbed through intact skin and mucosal membranes. Prolonged exposure, large doses, and/or application to compromised skin or mucosa can result in elevated plasma concentrations of lidocaine. 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. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine topical should be administered cautiously and dosing modified for repeated doses in patients with compromised renal function.
Moderate:
quinine
quiNINE has a moderate potential interaction with Renal Dysfunction.
Clearance of quinine is decreased in patients with severe chronic renal failure. The dosage and dosing frequency should be reduced. The effects of mild and moderate renal impairment on the safety and pharmacokinetics of quinine sulfate are not known. Monitoring is advised.
Seizures
Major:
benzethonium chloride / lidocaine topical
The lidocaine topical in benzethonium chloride / lidocaine topical has a major potential interaction with Seizures.
Lidocaine topical is absorbed through intact skin and mucosal membranes. Prolonged exposure, large doses, and/or application to compromised skin or mucosa can result in elevated plasma concentrations of lidocaine. Seizures can occur as a result of accumulation of active metabolites. Therapy with lidocaine topical should be administered cautiously to patients with or predisposed to seizure disorders.
Shock
Major:
benzethonium chloride / lidocaine topical
The lidocaine topical in benzethonium chloride / lidocaine topical has a major potential interaction with Shock.
Lidocaine is absorbed through intact skin and mucosal membranes following topical administration. Prolonged exposure, large doses, frequent applications and/or use on compromised skin or mucosa can produce systemic effects. At high plasma levels, lidocaine can cause hypotension, bradycardia, and cardiovascular collapse. Therapy with lidocaine topical should be administered cautiously in patients with shock, sinus bradyarrhythmia, or severe heart block. The recommended dosage should not be exceeded. Children and debilitated, elderly, or acutely ill patients should be given reduced dosages commensurate with their age, weight, and physical condition.
Teething Syndrome
Major:
benzethonium chloride / lidocaine topical
The lidocaine topical in benzethonium chloride / lidocaine topical has a major potential interaction with Teething Syndrome.
Topical lidocaine is not recommended to be used in teething infants and young children, as its ingestion is dangerous and potentially fatal. Ingestion of the drug has shown to result in seizures, severe brain injury, and heart problems in children.
Thrombocytopenia
Major:
quinine
quiNINE has a major potential interaction with Thrombocytopenia.
Quinine is contraindicated in patients with thrombocytopenia. Quinine can produce an immune-mediated thrombocytopenia. Severe cases of thrombocytopenia that are fatal or life threatening have been reported. Chronic renal impairment associated with the development of TTP has also been reported. Thrombocytopenia usually resolves within a week upon discontinuation of quinine. If quinine is not stopped, patients can be at risk for fatal hemorrhage. Upon re- exposure to quinine from any source, a patient with quinine- dependent antibodies could develop thrombocytopenia that is more rapid in onset and more severe than the original episode.
Tinnitus
Major:
quinine
quiNINE has a major potential interaction with Tinnitus.
The use of quinine is contraindicated in patients with tinnitus. Quinine has been associated with reversible and irreversible ototoxicity. Reversible hearing loss, tinnitus, and dizziness has been reported in 20% of patients receiving therapeutic doses of quinine. Cystic degeneration of stria vascularis, degeneration of the cochlear neurons, and loss of hair cells occur. Injury may be produced by spasm of cochlear blood vessels, resulting in anoxia and subsequent cellular damage.
Visual Defect/Disturbance
Major:
quinine
quiNINE has a major potential interaction with Visual Defect/Disturbance.
The use of quinine is contraindicated in patients with optic neuritis, and cautious use, if at all, is advised for patients with retinopathy or other visual defects. Quinine may affect the retina and optic nerve, producing visual disturbances that include blurred vision with scotomata, photophobia, diplopia, constricted visual fields, night blindness, and abnormal color perception. Although ocular toxicity is usually reversible following drug withdrawal, retinopathy and optic atrophy can occur in severe cases. All patients should be advised to immediately discontinue the drug and contact a physician if visual disturbances occur or are exacerbated during quinine therapy.
More resources
benzethonium chloride / lidocaine topical
A total of 122 drugs are known to interact with benzethonium chloride / lidocaine topical.
- Benzethonium chloride / lidocaine topical is in the drug class miscellaneous topical agents.
quinine
A total of 519 drugs are known to interact with quinine.
- Quinine is in the drug class antimalarial quinolines.
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Quinine is used to treat the following conditions:
- Malaria
- Myotonia Congenita (off-label)
- Nocturnal Leg Cramps (off-label)
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.