Interactions between Brevibloc and Diprivan

The esmolol in Brevibloc has a major potential interaction with Allergies.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

The esmolol in Brevibloc has a moderate potential interaction with Asthma.

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

The propofol in Diprivan has a moderate potential interaction with Burns, External.

Reports of mean urinary zinc loss during propofol therapy was approximately 2.5 to 3.0 mg/day in adult patients and 1.5 to 2.0 mg/day in pediatric patients. Practitioners should consider the administration of supplemental zinc during prolonged therapy with propofol in patients who are predisposed to zinc deficiency, such as those with burns, diarrhea, and/or major sepsis. Monitoring is recommended in these patients.

The esmolol in Brevibloc has a major potential interaction with Cardiogenic Shock.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

The propofol in Diprivan has a major potential interaction with Cerebral Vascular Disorder.

Propofol can induce severe hypotension and/or cardiovascular depression, particularly during the induction phase of sedation or anesthesia. Use of propofol infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis,hepatomegaly, renal failure, ECG changes (ST segment elevation similar to that in Brugada syndrome) and/or cardiac failure. Therapy with propofol should be administered cautiously in patients with preexisting cardiovascular disorders, hemodynamic impairment, increased intracranial pressure, or impaired cerebral circulation.

The esmolol in Brevibloc has a moderate potential interaction with Cerebrovascular Insufficiency.

Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

The esmolol in Brevibloc has a moderate potential interaction with COPD.

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

The esmolol in Brevibloc has a major potential interaction with Diabetes Mellitus.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

The propofol in Diprivan has a moderate potential interaction with Diarrhea.

Reports of mean urinary zinc loss during propofol therapy was approximately 2.5 to 3.0 mg/day in adult patients and 1.5 to 2.0 mg/day in pediatric patients. Practitioners should consider the administration of supplemental zinc during prolonged therapy with propofol in patients who are predisposed to zinc deficiency, such as those with burns, diarrhea, and/or major sepsis. Monitoring is recommended in these patients.

The esmolol in Brevibloc has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

The esmolol in Brevibloc has a major potential interaction with Heart Block.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

The propofol in Diprivan has a major potential interaction with Heart Block.

Propofol can induce severe hypotension and/or cardiovascular depression, particularly during the induction phase of sedation or anesthesia. Use of propofol infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis,hepatomegaly, renal failure, ECG changes (ST segment elevation similar to that in Brugada syndrome) and/or cardiac failure. Therapy with propofol should be administered cautiously in patients with preexisting cardiovascular disorders, hemodynamic impairment, increased intracranial pressure, or impaired cerebral circulation.

The esmolol in Brevibloc has a major potential interaction with Heart Failure.

Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

The propofol in Diprivan has a moderate potential interaction with High Cholesterol.

Propofol is formulated in an oil-and-water emulsion and elevated triglycerides can occur during extended therapy. Propofol should be administered cautiously in patients with lipid disorders such as primary hyperlipoproteinemia, diabetic hyperlipemia, and pancreatitis. Each milliliter of propofol contains 0.1g of fat (1.1 kcal).

The esmolol in Brevibloc has a moderate potential interaction with Hyperthyroidism.

When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

The esmolol in Brevibloc has a major potential interaction with Hypotension.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

The propofol in Diprivan has a major potential interaction with Hypotension.

Propofol can induce severe hypotension and/or cardiovascular depression, particularly during the induction phase of sedation or anesthesia. Use of propofol infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis,hepatomegaly, renal failure, ECG changes (ST segment elevation similar to that in Brugada syndrome) and/or cardiac failure. Therapy with propofol should be administered cautiously in patients with preexisting cardiovascular disorders, hemodynamic impairment, increased intracranial pressure, or impaired cerebral circulation.

The esmolol in Brevibloc has a major potential interaction with Ischemic Heart Disease.

Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

The propofol in Diprivan has a major potential interaction with Ischemic Heart Disease.

Propofol can induce severe hypotension and/or cardiovascular depression, particularly during the induction phase of sedation or anesthesia. Use of propofol infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis,hepatomegaly, renal failure, ECG changes (ST segment elevation similar to that in Brugada syndrome) and/or cardiac failure. Therapy with propofol should be administered cautiously in patients with preexisting cardiovascular disorders, hemodynamic impairment, increased intracranial pressure, or impaired cerebral circulation.

The esmolol in Brevibloc has a moderate potential interaction with Myasthenia Gravis.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

The esmolol in Brevibloc has a major potential interaction with Peripheral Arterial Disease.

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

The esmolol in Brevibloc has a moderate potential interaction with Pheochromocytoma.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta receptor-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

The esmolol in Brevibloc has a moderate potential interaction with Psoriasis.

The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

The esmolol in Brevibloc has a moderate potential interaction with Renal Dysfunction.

Esmolol is metabolized in the cytosol of red blood cells. The resultant acid metabolite is slightly active and is primarily eliminated by the kidney. The clearance of this metabolite is significantly decreased in patients with renal impairment, although the clinical consequences of metabolite accumulation are unknown. Therapy with esmolol should be administered cautiously in patients with renal dysfunction.

The propofol in Diprivan has a moderate potential interaction with Renal Dysfunction.

At high doses (2-3 grams per day), EDTA has been reported, on rare occasions, to be toxic to the renal tubules. Studies to-date, in patients with normal or impaired renal function have not shown any alteration in renal function with propofol Injectable Emulsion containing 0.005% disodium edetate. In patients at risk for renal impairment, urinalysis and urine sediment should be checked before initiation of sedation and then be monitored on alternate days during sedation.

The propofol in Diprivan has a moderate potential interaction with Seizures.

Patients with seizure disorders are at increased risk of seizure activity during the recovery phase of sedation or anesthesia following administration of propofol. Clinical monitoring of seizure activity is recommended in patients with or predisposed to seizure disorders.

The propofol in Diprivan has a moderate potential interaction with Sepsis.

Reports of mean urinary zinc loss during propofol therapy was approximately 2.5 to 3.0 mg/day in adult patients and 1.5 to 2.0 mg/day in pediatric patients. Practitioners should consider the administration of supplemental zinc during prolonged therapy with propofol in patients who are predisposed to zinc deficiency, such as those with burns, diarrhea, and/or major sepsis. Monitoring is recommended in these patients.

The esmolol in Brevibloc has a major potential interaction with Sinus Node Dysfunction.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

The propofol in Diprivan has a major potential interaction with Tachyarrhythmia.

Propofol can induce severe hypotension and/or cardiovascular depression, particularly during the induction phase of sedation or anesthesia. Use of propofol infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis,hepatomegaly, renal failure, ECG changes (ST segment elevation similar to that in Brugada syndrome) and/or cardiac failure. Therapy with propofol should be administered cautiously in patients with preexisting cardiovascular disorders, hemodynamic impairment, increased intracranial pressure, or impaired cerebral circulation.

The esmolol in Brevibloc has a moderate potential interaction with Tachyarrhythmia.

Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.

The propofol in Diprivan has a moderate potential interaction with Zinc Deficiency.

Reports of mean urinary zinc loss during propofol therapy was approximately 2.5 to 3.0 mg/day in adult patients and 1.5 to 2.0 mg/day in pediatric patients. Practitioners should consider the administration of supplemental zinc during prolonged therapy with propofol in patients who are predisposed to zinc deficiency, such as those with burns, diarrhea, and/or major sepsis. Monitoring is recommended in these patients.