Skip to main content

Drug Interactions between DermacinRx Lidotral and penbutolol

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

penbutolol lidocaine topical

Applies to: penbutolol and DermacinRx Lidotral (lidocaine topical)

MONITOR: Some beta-blockers may increase lidocaine levels and risk of toxicity. This interaction may also apply to topical formulations of lidocaine. The proposed mechanism is inhibition of CYP450 metabolism and/or decreased cardiac output and hepatic blood flow resulting in decreased hepatic metabolism of lidocaine. In addition, beta-blockers and lidocaine may also have additive negative inotropic effects on the heart. Data have been conflicting and variable. The degree of systemic absorption of topical lidocaine may be dependent on the duration of application and the applied surface area.

MANAGEMENT: Patients receiving concurrent therapy should be monitored for drowsiness, mental status changes, bradycardia, and hypotension. Lidocaine levels should be obtained when clinically necessary. If toxicity is suspected, the lidocaine infusion should be decreased, as possible or the topical formulation of lidocaine should be discontinued.

References (13)
  1. Miners JO, Wing MH, Lillywhite KJ, Smith KJ (1984) "Failure of "therapeutic" doses of beta-adrenoceptor antagonists to alter the disposition of tolbutamide and lignocaine." Br J Clin Pharmacol, 18, p. 853-60
  2. Ochs HR, Carstens G, Greenblatt DJ (1980) "Reduction in lidocaine clearance during continuous infusion and by coadministration of propranolol." N Engl J Med, 303, p. 373-7
  3. Schneck DW, Luderer JR, Davis D, Vary J (1984) "Effects of nadolol and propranolol on plasma lidocaine clearance." Clin Pharmacol Ther, 36, p. 584-7
  4. Svendsen TL, Tango M, Waldorff S, et al. (1982) "Effects of propranolol and pindolol on plasma lignocaine clearance in man." Br J Clin Pharmacol, 13, s223-6
  5. Conrad KA, Byers JM, Finley PR, Burnham L (1983) "Lidocaine elimination: effects of metoprolol and of propranolol." Clin Pharmacol Ther, 33, p. 133-8
  6. Jordo L, Johnsson G, Lundborg P, Regardh CG (1984) "Pharmacokinetics of lidocaine in healthy individuals pretreated with multiple doses of metoprolol." Int J Clin Pharmacol Ther Toxicol, 22, p. 312-5
  7. Graham CF, Turner WM, Jones JK (1981) "Lidocaine-propranolol interactions ." N Engl J Med, 304, p. 1301
  8. Ochs HR, Skanderra D, Abernethy DR, Greenblatt DJ (1983) "Effect of penbutolol on lidocaine kinetics." Arzneimittelforschung, 33, p. 1680-1
  9. Bax ND, Tucker GT, Lennard MS, Woods HF (1985) "The impairment of lignocaine clearance by propranolol: major contribution from enzyme inhibition." Br J Clin Pharmacol, 19, p. 597-603
  10. Parker G, Ene MD, Daneshmend TK, Roberts CJ (1984) "Do beta blockers differ in their effects on hepatic microsomal enzymes and liver blood flow?" J Clin Pharmacol, 24, p. 493-9
  11. (2023) "Product Information. LMX 4 (lidocaine topical)." Ferndale Pharmaceuticals Ltd
  12. (2021) "Product Information. Versatis (lidocaine topical)." Seqirus Pty Ltd
  13. (2024) "Product Information. Xylocaine Topical (lidocaine topical)." Aspen Pharmacare Australia Pty Ltd

Drug and food interactions

Moderate

penbutolol food

Applies to: penbutolol

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd
Moderate

penbutolol food

Applies to: penbutolol

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References (1)
  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer