Drug Interactions between bupivacaine / ketamine / ketorolac and tofacitinib

Using ketamine together with ethanol (alcohol) may increase side effects such as dizziness, drowsiness, confusion, difficulty concentrating, excessive sedation, and respiratory depression. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with ketamine. Also avoid activities requiring mental alertness such as driving, operating hazardous machinery, or engaging in potentially hazardous activities until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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.

Alcohol can increase the nervous system side effects of ketamine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should not drink alcohol during treatment with ketamine. If you have received ketamine for anesthesia, you should avoid activities requiring mental alertness such as driving or operating hazardous machinery for at least 24 hours and until you know how the medication affects you. If you are taking ketamine orally, you should also avoid the consumption of grapefruit or grapefruit juice, which can significantly increase blood levels and side effects of the medication. Talk to your doctor if you have any questions or concerns. 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.

Consumer information for this interaction is not currently available.

MONITOR: Grapefruit juice may increase the plasma concentrations of tofacitinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The extent and clinical significance are unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.

MANAGEMENT: Until more information is available, some authorities recommend avoiding consumption of grapefruit juice during tofacitinib therapy (Canada). Patients receiving tofacitinib therapy who ingest grapefruits or grapefruit juice should be monitored for adverse effects and undue fluctuations in plasma drug levels.

Ask your doctor before using ketorolac together with ethanol (alcohol). Do not drink alcohol while taking ketorolac. Alcohol can increase your risk of stomach bleeding caused by ketorolac. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. 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.