Drug Interactions between bupivacaine / dexamethasone / epinephrine and desirudin

GENERALLY AVOID: Drugs that can affect hemostasis such as dextrans, systemic glucocorticoids, thrombolytic agents, or other anticoagulants may potentiate the risk of bleeding complications associated with the use of desirudin. In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during desirudin therapy may also be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

MANAGEMENT: During prophylaxis of venous thromboembolism, concomitant treatment with heparins or dextrans is not recommended. The effects of desirudin and unfractionated heparins on prolongation of activated partial thromboplastin time (aPTT) are additive. In general, any agent which may enhance the risk of hemorrhage should be discontinued prior to initiation of desirudin therapy. If coadministration is necessary, it should be undertaken with caution and only after thorough assessment of risks and benefits. Close clinical and laboratory observation for bleeding complications is recommended. Patients undergoing neuraxial intervention and treated with these agents should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction.