Can you take Flavalta with Sirolimus?
1 drug interaction and 30 additional warnings found for the following 2 drugs:
- Flavalta (epinephrine/lidocaine)
- sirolimus
Drug interactions
Moderate drug interactions
Moderate:
lidocaine sirolimus
Applies to: Flavalta (epinephrine / lidocaine) and sirolimus
Using sirolimus together with lidocaine may increase the blood levels and effects of one or both medications.
Contact your doctor if your condition changes or you experience increased side effects. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.
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.
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
lidocaine Food/Lifestyle
Applies to: Flavalta (epinephrine / lidocaine)
Grapefruit juice may increase the blood levels of lidocaine, which may increase the risk of side effects such as:
- low blood pressure
- slow heart rate
- irregular heart rhythm
- difficulty breathing
- convulsions
Cigarette smoking may reduce the blood levels of lidocaine, which may make the medication less effective. It is best to avoid smoking during lidocaine therapy.
Consuming cruciferous vegetables (e.G., broccoli, brussels sprouts) may also reduce the blood levels of lidocaine.
Talk to a healthcare professional 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.
Moderate:
sirolimus Food/Lifestyle
Applies to: sirolimus
Grapefruit and grapefruit juice may interact with sirolimus and could lead to potentially dangerous effects. Avoid eating grapefruit or drinking grapefruit juice while you are taking sirolimus.
Also, you should preferably take sirolimus at least one hour before eating. If you do take it with food, you should take it each time with food to avoid changes in sirolimus levels.
The oral liquid form of sirolimus must be mixed with water or orange juice only. Do not use grapefruit juice to mix this medication.
Moderate:
EPINEPHrine Caffeine
Applies to: Flavalta (epinephrine / lidocaine)
Both EPINEPHrine and caffeine can increase blood pressure and heart rate, and combining them may enhance these effects.
Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.
Contact your doctor if your condition changes or you experience increased side effects.
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.
Moderate:
lidocaine Nicotine
Applies to: Flavalta (epinephrine / lidocaine)
As you stop smoking during treatment with nicotine, your dosage requirement of lidocaine may need to be changed. Talk to your doctor if you have any questions or concerns.
Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.
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.
Disease interactions
26 potential interactions Applies to: 23 conditions, including High Cholesterol, Heart Failure, Seizures, Hypokalemia, and Hypotension.
Acidosis
Moderate:
Flavalta
The EPINEPHrine in Flavalta has a moderate potential interaction with Acidosis.
Acidosis, hypoxia, and hypercapnia may reduce the effectiveness of sympathomimetic amines in raising blood pressure. These conditions should be corrected before initiating therapy with sympathomimetic amines, if possible. Monitoring the patients acid-base balance, carbon dioxide levels, and oxygen saturation is recommended.
Angioedema
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with Angioedema.
Sirolimus has been associated with the development of angioedema. Patients at risk of developing angioedema and those using concomitant drugs known to cause angioedema, such as ACE inhibitors, may be at increased risk of developing angioedema. Care should be taken when prescribing this agent in patients at risk and close monitoring is recommended.
Cardiovascular Conditions and Disorders
Major:
Flavalta
The EPINEPHrine in Flavalta has a major potential interaction with Cardiovascular Conditions and Disorders.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Dehydration
Major:
Flavalta
The EPINEPHrine in Flavalta has a major potential interaction with Dehydration.
The use of sympathomimetic amines has been infrequently associated with significant hypotension especially in dehydrated patients secondary to the drug's beta-2 mediated vasodilation. Hypovolemia should be corrected, if possible, before administering sympathomimetic amines. Blood pressure and ECG should be monitored at regular intervals. Monitoring of cardiac output and pulmonary wedge pressure may also be desired.
Diabetes Mellitus
Moderate:
Flavalta
The EPINEPHrine in Flavalta has a moderate potential interaction with Diabetes Mellitus.
Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.
Heart Block
Major:
Flavalta
The lidocaine in Flavalta has a major potential interaction with Heart Block.
The use of lidocaine is contraindicated in patients with Stokes-Adam syndrome, Wolff-Parkinson White syndrome, or second- or third-degree AV block in the absence of a functional artificial pacemaker, or congenital QT prolongation.
Heart Failure
Major:
Flavalta
The lidocaine in Flavalta has a major potential interaction with Heart Failure.
Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.
High Cholesterol
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with High Cholesterol.
The use of sirolimus may increase serum cholesterol and triglycerides. Care should be taken when prescribing this agent to hyperlipidemic patients. It is recommended to assess the risk/benefit carefully when considering this agent in patients with established hyperlipidemia before initiating therapy. It is recommended to monitor patients regularly for elevated lipids.
Hyperkalemia
Moderate:
Flavalta
The lidocaine in Flavalta has a moderate potential interaction with Hyperkalemia.
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
Hyperthyroidism
Major:
Flavalta
The EPINEPHrine in Flavalta has a major potential interaction with Hyperthyroidism.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Hypokalemia
Moderate:
Flavalta
The lidocaine in Flavalta has a moderate potential interaction with Hypokalemia.
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
Hypotension
Major:
Flavalta
The lidocaine in Flavalta has a major potential interaction with Hypotension.
Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.
Immunodeficiency
Major:
sirolimus
Sirolimus has a major potential interaction with Immunodeficiency.
Immunosuppressive agents may increase the risk of progressive multifocal leukoencephalopathy (PML). Certain agents are contraindicated in patients who have or have had PML. Patients receiving chronic immunosuppressant or immunomodulatory therapy or who have systemic medical conditions resulting in significantly compromised immune system function should not be treated with these agents. Health care professionals should monitor patients for any new sign or symptom suggestive of PML. Therapy dosing should be withheld immediately and an appropriate diagnostic evaluation should be performed at the first sign or symptom suggestive of PML.
Infection
Major:
sirolimus
Sirolimus has a major potential interaction with Infection.
Serious and sometimes fatal infections have been reported in patients receiving immunosuppressive agents. Patients receiving immunosuppressants are at increased risk of developing bacterial, viral, fungal, and protozoal infections, and new or reactivated viral infections including opportunistic infections. Caution should be exercised when considering their use in patients with severe or chronic infections. It is recommended to interrupt therapy in patients who develop a new infection while undergoing treatment and to monitor these patients closely for any sign or symptom indicative of infection.
Liver Disease
Major:
Flavalta
The lidocaine in Flavalta has a major potential interaction with Liver Disease.
Lidocaine is rapidly and extensively metabolized by the liver. Less than 10% is eliminated unchanged in the urine. Several inactive and two active forms (MEGX and GX) have been identified. MEGX and GX exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. The pharmacokinetic disposition of lidocaine is altered by changes in hepatic function, including hepatic blood flow. Therapy with lidocaine should be administered cautiously and dosing modifications for repeated or loading and maintenance doses may be necessary. Clinical monitoring of cardiac (continuous ECG) is required and serum metabolite concentrations and monitoring hepatic function are recommended.
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with Liver Disease.
Sirolimus is extensively metabolized in the intestinal wall and liver and undergoes counter-transport from enterocytes of the small intestine into the gut lumen. The maintenance dose of sirolimus should be reduced by approximately one third in patients with mild or moderate hepatic impairment and by approximately one half in patients with severe hepatic impairment. It is not necessary to modify the sirolimus loading dose. Care should be taken when prescribing this agent to patients with liver impairment and close monitoring is recommended.
Magnesium Imbalance
Moderate:
Flavalta
The lidocaine in Flavalta has a moderate potential interaction with Magnesium Imbalance.
Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.
Neurological Disorders
Moderate:
Flavalta
The EPINEPHrine in Flavalta has a moderate potential interaction with Neurological Disorders.
Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.
Organ Transplant
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with Organ Transplant.
The use of sirolimus in lung transplant patients is not recommended as the safety and efficacy of this agent as immunosuppressive therapy has not been established in these patients. Cases of bronchial anastomotic dehiscence, most fatal, have been reported in de novo lung transplant patients when sirolimus has been used as part of an immunosuppressive regimen.
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with Organ Transplant.
The use of sirolimus is not recommended in liver transplant patients as its safety and efficacy has not been established in these patients. The use of sirolimus has been associated with adverse outcomes in patients following liver transplantation, including excess mortality, graft loss and hepatic artery thrombosis.
Parkinsonism
Moderate:
Flavalta
The EPINEPHrine in Flavalta has a moderate potential interaction with Parkinsonism.
Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.
Pheochromocytoma
Major:
Flavalta
The EPINEPHrine in Flavalta has a major potential interaction with Pheochromocytoma.
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
Pulmonary Impairment
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with Pulmonary Impairment.
Interstitial Lung Disease (ILD)/Pneumonitis, including pneumonitis, bronchiolitis obliterans organizing pneumonia, and pulmonary fibrosis, some fatal, with no identified infectious etiology have occurred with the use of sirolimus. Monitor patients for pulmonary symptoms indicative of ILD/pneumonitis and discontinue sirolimus and assess patients developing ILD or pneumonitis.
Renal Dysfunction
Major:
Flavalta
The lidocaine in Flavalta has a major potential interaction with Renal Dysfunction.
Lidocaine is primarily eliminated by the kidney. Less than 10% is eliminated unchanged in the urine. Two active metabolites (MEGX and GX) have been identified that exhibit antiarrhythmic and convulsant properties. GX accumulates during prolonged intravenous lidocaine infusion. Serum concentrations of lidocaine and the active metabolites are increased and the half-life prolonged in patients with renal impairment. Therapy with lidocaine should be administered cautiously and dosing modified for repeated or maintenance doses in patients with compromised renal function. Clinical monitoring of cardiac function (continual ECG) is required and serum metabolite concentrations and monitoring renal function are recommended.
Moderate:
sirolimus
Sirolimus has a moderate potential interaction with Renal Dysfunction.
Renal function should be closely monitored during the co-administration of sirolimus with cyclosporine, because long-term administration of the combination has been associated with deterioration of renal function. It is recommended to adjust therapy regimen, including discontinuation of sirolimus and/or cyclosporine in patients with elevated or increasing serum creatinine levels. Caution should be exercised when using agents (e.g., aminoglycosides and amphotericin B) that are known to have a deleterious effect on renal function. Periodic monitoring of renal function is recommended, including quantitative monitoring of urinary protein excretion.
Seizures
Major:
Flavalta
The lidocaine in Flavalta has a major potential interaction with Seizures.
Seizures have occurred during lidocaine therapy and have been associated with the rapid administration of a large intravenous doses or accumulation of active metabolites with maintenance therapy. Therapy with lidocaine should be administered cautiously to patients with or predisposed to seizure disorders. Clinical monitoring of cardiac (continuous ECG) is required, and serum metabolite concentrations are recommended.
More resources
Flavalta
A total of 726 drugs are known to interact with Flavalta.
- Flavalta is in the drug class local injectable anesthetics.
- Flavalta is used to treat Local Anesthesia.
sirolimus
A total of 758 drugs are known to interact with sirolimus.
- Sirolimus is in the following drug classes: mTOR inhibitors, selective immunosuppressants.
- Sirolimus is used to treat the following conditions:
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 interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.