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Drug Interactions between halothane and R.E.C.K.

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

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Interactions between your drugs

Major

halothane EPINEPHrine

Applies to: halothane and R.E.C.K. (clonidine / epinephrine / ketorolac / ropivacaine)

GENERALLY AVOID: Rarely, the combination of epinephrine and some anesthetics has resulted in ventricular irritability, serious cardiac arrhythmias, or death. The halogenated anesthetics sensitize the heart to the arrhythmogenic effects of catecholamines.

MANAGEMENT: This combination should be avoided or used very cautiously. If a halogenated anesthetic and epinephrine must be used together, an epinephrine concentration of 1:100,000 or 1:200,000 is recommended. The adult dosage should not exceed 100 mcg of a 1:100,000 solution in any 10-minute period. The patient's hemodynamic status should be closely monitored. Lidocaine has a protective effect against the arrhythmogenic potential of epinephrine. Topical epinephrine appears to be relatively safe for use during anesthesia.

References (20)
  1. Ueda W, Hirakawa M, Mae O (1983) "Appraisal of epinephrine administration to patients under halothane anesthesia for closure of cleft palate." Anesthesiology, 58, p. 574-6
  2. Ghoneim MM (1971) "Drug interaction in anaesthesia. A review." Can Anaesth Soc J, 18, p. 353-75
  3. Cullen BF, Miller MG (1979) "Drug interactions and anesthesia: a review." Anesth Analg, 58, p. 413-23
  4. Cooke JE (1985) "Drug interactions in anesthesia." Clin Plast Surg, 12, p. 83-9
  5. Forbes AM (1966) "Halothane, adrenaline and cardiac arrest." Anaesthesia, 21, p. 22-7
  6. Kainuma M, Suzuki A (1986) "Convulsions after adrenaline administration during enflurane anaesthesia." Anaesthesia, 41, p. 874-5
  7. Horrigan RW, Eger EI, Wilson C (1978) "Epinephrine-induced arrhythmias during enflurane anesthesia in man: a nonlinear dose-response relationship and dose-dependent protection from lidocaine." Anesth Analg, 57, p. 547-50
  8. Reisner LS, Lippmann M (1977) "Further data on epinephrine interactions." Anesth Analg, 56, p. 468
  9. Johnston RR, Eger EI II, Wilson C (1976) "A comparative interaction of epinephrine with enflurane, isoflurane, and halothane in man." Anesth Analg, 55, p. 709-12
  10. Reisner LS, Lippmann M (1975) "Ventricular arrhythmias after epinephrine injection in enflurane and in halothane anesthesia." Anesth Analg, 54, p. 468-70
  11. Snow JC, Shamsai J, Sakarya I (1968) "Effects of epinephrine during halothane anesthesia in mastoidotympanoplastic surgery." Anesth Analg, 47, p. 252-6
  12. Karl HW, Swedlow DB, Lee KW, Downes JJ (1983) "Epinephrine-halothane interactions in children." Anesthesiology, 58, p. 142-5
  13. Mostello L, Stueber K, Lake CR (1988) "Is topical application of epinephrine at skin graft donor sites during halothane anesthesia safe?" Ann Plast Surg, 20, p. 313-6
  14. Hirshom WI, Taylor RG, Sheehan JC (1964) "Arrhythmias produced by combinations of halothane and small amounts of vasopressor." Br J Oral Surg, 2, p. 131-6
  15. Bennett JA, Eltringham RJ (1977) "Possible dangers of anaesthesia in patients receiving fenfluramine. Results of animal studies following a case of human cardiac arrest." Anaesthesia, 32, p. 8-13
  16. Konchigeri HN, Shaker MH, Winnie AP (1974) "Effect of epinephrine during enflurane anesthesia." Anesth Analg, 53, p. 894-7
  17. Pepple J (1984) "Epinephrine-halothane interaction in children versus adults." Anesthesiology, 60, p. 76-8
  18. Smith RB (1981) "Drug interactions and drug reactions." Otolaryngol Clin North Am, 14, p. 615-29
  19. (2001) "Product Information. Ultane (sevoflurane)." Abbott Pharmaceutical
  20. (2001) "Product Information. Fluothane (halothane)." Wyeth-Ayerst Laboratories

Drug and food interactions

Moderate

cloNIDine food

Applies to: R.E.C.K. (clonidine / epinephrine / ketorolac / ropivacaine)

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

ketorolac food

Applies to: R.E.C.K. (clonidine / epinephrine / ketorolac / ropivacaine)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References (1)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
Moderate

EPINEPHrine food

Applies to: R.E.C.K. (clonidine / epinephrine / ketorolac / ropivacaine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References (7)
  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company

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

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