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Drug Interactions between bupivacaine / hydromorphone and procainamide

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

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Interactions between your drugs

Moderate

procainamide BUPivacaine

Applies to: procainamide and bupivacaine / hydromorphone

MONITOR: Amide-type local anesthetics (e.g., lidocaine, bupivacaine, ropivacaine) may have additive cardiac effects when coadministered with class I antiarrhythmic agents. In general, the toxic effects of amide-type anesthetics when coadministered with structurally related antiarrhythmic agents are additive and potentially synergistic which may lead to bradycardia, chest pain, heart block, arrhythmias, ECG abnormalities, and cardiac arrest. The clinical significance of the interaction has not been established.

MANAGEMENT: If coadministration of amide-type local anesthetics with class I antiarrhythmic agents (e.g., procainamide, mexiletine, disopyramide) is required, caution and clinical monitoring are recommended for additive cardiac effects. Advise patients to contact their physician if they experience adverse effects such as chest pain, palpitations, nausea, vomiting, lightheadedness, nervousness, dizziness, or tremors.

References (3)
  1. (2015) "Product Information. Lidocaine Hydrochloride (lidocaine)." Hospira Healthcare Corporation
  2. (2022) "Product Information. Lidocaine Hydrochloride (lidocaine)." Hameln Pharma Ltd
  3. (2022) "Product Information. Xylocaine HCl (lidocaine)." Aspen Pharmacare Australia Pty Ltd

Drug and food interactions

Major

HYDROmorphone food

Applies to: bupivacaine / hydromorphone

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydromorphone. 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.

GENERALLY AVOID: Consumption of alcohol while taking sustained-release formulations of hydromorphone may cause rapid release of the drug, resulting in high systemic levels of hydromorphone that may be potentially lethal even in opioid-tolerant patients. Alcohol appears to disrupt the extended release mechanism, causing 'dose-dumping' into the bloodstream. In 48 healthy volunteers, coadministration of a 12 mg dose of sustained-release hydromorphone with 240 mL of 40% (80 proof) alcohol resulted in a mean peak hydromorphone concentration (Cmax) approximately six times greater than when taken with water. One subject had a 16-fold increase in hydromorphone Cmax with 40% alcohol compared to water. In some subjects, coadministration with 8 ounces of 4% alcohol (equivalent to 2/3 of a typical serving of beer) resulted in almost twice the hydromorphone Cmax than when coadministered with water. The effect of alcohol was more pronounced in a fasted state.

MANAGEMENT: Patients taking sustained-release formulations of hydromorphone should not consume alcohol or use medications that contain alcohol on days of hydromorphone dosing. In general, potent narcotics such as hydromorphone should not be combined with alcohol.

References (3)
  1. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  2. (2001) "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company
  3. FDA. U.S. Food and Drug Administration (2005) Healthcare Professional Sheet. FDA Alert [07/2005]: alcohol-palladone interaction. http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone
Minor

procainamide food

Applies to: procainamide

Ethanol may increase the acetylation of procainamide. Subtherapeutic plasma levels of procainamide may result in some patients. Because the acetylated metabolite of procainamide also possesses antiarrhythmic properties, the clinical effects are unclear.

References (1)
  1. Olsen H, Morland J (1982) "Ethanol-induced increase in procainamide acetylation in man." Br J Clin Pharmacol, 13, p. 203-8

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

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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