Drug interactions between epinephrine / prilocaine and Paracetamol
Interactions between your drugs
Applies to: Paracetamol (acetaminophen) and epinephrine / prilocaine
Consumer information for this interaction is not currently available.
MONITOR CLOSELY: Prilocaine can cause dose-related methemoglobin formation via its ortho-toluidine metabolite. Coadministration with other agents that are also associated with methemoglobinemia including other local anesthetics (e.g., benzocaine, lidocaine), antimalarials (e.g., chloroquine, primaquine, quinine, tafenoquine), nitrates and nitrites, sulfonamides, acetaminophen, aminosalicylic acid, dapsone, dimethyl sulfoxide, flutamide, metoclopramide (primarily in infants), nitrofurantoin (primarily in infants), phenazopyridine, phenobarbital, phenytoin, and rasburicase may increase the risk. Additional risk factors include very young age, anemia, cardiac/pulmonary disease, peripheral vascular disease, shock, sepsis, acidosis, and genetic predisposition (e.g., NADH cytochrome-b5 reductase deficiency; glucose-6-phosphate dehydrogenase deficiency; hemoglobin M). The development of methemoglobinemia due to prilocaine is usually dose-related and asymptomatic in normal patients receiving recommended doses, but symptoms may occur at any dose in susceptible individuals. Neonates and infants are particularly susceptible due to a lower activity of the enzyme that reduces methemoglobin to hemoglobin. Neonatal methemoglobinemia has been reported after paracervical or pudendal block in the obstetric patient. The repeated administration of prilocaine, even in relatively small doses, can lead to clinically overt methemoglobinemia (cyanosis). Prilocaine is therefore not recommended for continuous techniques of regional anesthesia.
MANAGEMENT: Prilocaine should be used with caution in the presence of other methemoglobin-inducing drugs. Patients should be closely monitored to ensure adequate perfusion and oxygenation during treatment with prilocaine. Methemoglobin levels should be monitored and oxygen administered whenever possible. Signs and symptoms of methemoglobinemia may be delayed some hours after drug exposure. Patients or their caregivers should be advised to seek medical attention if they notice signs and symptoms of methemoglobinemia such as slate-grey cyanosis in buccal mucous membranes, lips, and nail beds; nausea; headache; dizziness; lightheadedness; lethargy; fatigue; dyspnea; tachypnea; tachycardia; anxiety; and confusion. In severe cases, patients may progress to central nervous system depression, stupor, seizures, acidosis, cardiac arrhythmias, syncope, and shock. Methemoglobinemia should be considered if central cyanosis is unresponsive to oxygen. Calculated oxygen saturation and pulse oximetry are generally not accurate in the setting of methemoglobinemia. The diagnosis can be confirmed by an elevated methemoglobin level of at least 10%. If patient does not respond to administration of oxygen, clinically significant methemoglobinemia should be treated with methylene blue 1 to 2 mg/kg by slow intravenous injection over 5 minutes.
- Ministerio de Sanidad y Consumo. Gobierno de España "AEMPS. Agencia Española de Medicamentos y Productos Sanitarios. Available from: URL: https://sinaem4.agemed.es/consaem/fichasTecnicas.do?metodo=detalleForm."
- Canadian Pharmacists Association "e-CPS. Available from: URL: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink."
- "Product Information. Citanest Plain (prilocaine)" Astra-Zeneca Pharmaceuticals, Wilmingtoon, DE.
- Cerner Multum, Inc. "Australian Product Information." O 0
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
Drug and food interactions
No results found in our database - however, this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.
Therapeutic duplication warnings
No therapeutic duplications were found for your selected drugs.
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|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.|
|No information available.|
Do not stop taking any medications without consulting your healthcare provider.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.