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Drug Interactions between bupivacaine / sufentanil and Tranxene SD

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

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Interactions between your drugs

Major

clorazepate SUFentanil

Applies to: Tranxene SD (clorazepate) and bupivacaine / sufentanil

GENERALLY AVOID: Concomitant use of opioids with benzodiazepines may result in profound sedation, respiratory depression, coma, and death. The use of benzodiazepines with sufentanil during induction has been reported to decrease mean arterial pressure and systemic vascular resistance. The mechanism appears to be an indirect effect on the autonomic nervous system.

MANAGEMENT: The use of opioids in conjunction with benzodiazepines or other CNS depressants should generally be avoided unless alternative treatment options are inadequate. If coadministration is necessary, the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect. Patients receiving sufentanil with benzodiazepines should be monitored closely for signs and symptoms of respiratory depression, altered hemodynamics, and hypotension.

References

  1. Thomson IR, MacAdams CL, Hudson RJ, Rosenbloom M "Drug interactions with sufentanil: hemodynamic effects of premedication and muscle relaxants." Anesthesiology 76 (1992): 922-9
  2. West JM, Estrada S, Heerdt M "Sudden hypotension associated with midazolam and sufentanil." Anesth Analg 66 (1987): 693-4
  3. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  4. "Product Information. Sufenta (sufentanil)." Janssen Pharmaceuticals PROD (2001):
  5. US Food and Drug Administration "FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM518672.pdf" (2016):
View all 5 references

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Moderate

BUPivacaine clorazepate

Applies to: bupivacaine / sufentanil and Tranxene SD (clorazepate)

MONITOR: The concomitant use of local anesthetics and benzodiazepines may have additive CNS-depressant effects. Both types of drugs are CNS depressants. Benzodiazepines administered at the same time raise the threshold for seizures, which is a sign of toxicity for local anesthetics. The data available from manufacturers in different countries is conflicting. Moreover, benzodiazepines (such as diazepam) may be used together with local anesthetics for emergencies in cases of overdosage, while considering the depressive effects benzodiazepines have on respiration and circulation.

MANAGEMENT: Caution is advised during concurrent use. Patients should be monitored for potentially excessive or prolonged CNS depression and other CNS adverse effects. Dosage adjustments may be required. The higher threshold for seizures should be kept in mind when patients receiving these drugs simultaneously are monitored for local anesthetic toxicity.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):

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Drug and food interactions

Moderate

clorazepate food

Applies to: Tranxene SD (clorazepate)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

SUFentanil food

Applies to: bupivacaine / sufentanil

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

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References

  1. Linnoila M, Hakkinen S "Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving." Clin Pharmacol Ther 15 (1974): 368-73
  2. Sturner WQ, Garriott JC "Deaths involving propoxyphene: a study of 41 cases over a two-year period." JAMA 223 (1973): 1125-30
  3. Girre C, Hirschhorn M, Bertaux L, et al. "Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers." Eur J Clin Pharmacol 41 (1991): 147-52
  4. Levine B, Saady J, Fierro M, Valentour J "A hydromorphone and ethanol fatality." J Forensic Sci 29 (1984): 655-9
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL "Pharmacokinetic interaction of propoxyphene with ethanol." Br J Clin Pharmacol 19 (1985): 398-401
  6. Carson DJ "Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases." Lancet 1 (1977): 894-7
  7. Rosser WW "The interaction of propoxyphene with other drugs." Can Med Assoc J 122 (1980): 149-50
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM "Distalgesic and ethanol-impaired function." Lancet 2 (1982): 384
  9. Kiplinger GF, Sokol G, Rodda BE "Effect of combined alcohol and propoxyphene on human performance." Arch Int Pharmacodyn Ther 212 (1974): 175-80
View all 9 references

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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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