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Drug Interactions between hyaluronidase 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

Moderate

EPINEPHrine hyaluronidase

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

GENERALLY AVOID: Hyaluronidase may enhance the absorption and dispersion of dopamine and/or other injectable alpha agonist drugs, resulting in cardiovascular effects such as increased blood pressure, increased vascular resistance and other alpha adrenergic-mediated adverse effects. Hyaluronidase is a dispersion agent, that can increase the permeability of connective tissue through the hydrolysis of hyaluronic acid. There are no clinical data available for this interaction.

MANAGEMENT: The manufacturer of hyaluronidase recommends avoiding the use of hyaluronidase to enhance the absorption and dispersion of dopamine and/or alpha agonist drugs. Some authorities consider this particular use of hyaluronidase as contraindicated. However, hyaluronidase used for other indications, may be administered to patients receiving dopamine and/or alpha agonist drugs. Consultation with product labeling and local or institutional guidelines may be appropriate for further recommendations.

References (6)
  1. (2018) "Product Information. Hylenex (hyaluronidase)." Halozyme Therapeutics
  2. (2024) "Product Information. Vitrase (hyaluronidase)." Bausch and Lomb Americas, Inc.
  3. (2024) "Product Information. Amphadase (hyaluronidase)." Amphastar Pharmaceuticals Inc
  4. (2015) "Product Information. Hyalase (hyaluronidase)." Wockhardt UK Ltd
  5. (2024) "Product Information. Hyalase (hyaluronidase)." Sanofi-Aventis Australia Pty Ltd
  6. king m, Convery C, davies e (2018) "This month's guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4)" J Clin Aesthet Dermatol, 11, p. 61-68
Minor

hyaluronidase ROPivacaine

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

When hyaluronidase is added to a local anesthetic, the local anesthetic solution undergoes increased absorption, resulting in a shorter duration of action and possible increased frequency of systemic reactions. The clinical significance is unknown. It may be advisable to monitor the patient for altered anesthetic efficacy and side effects.

References (2)
  1. (2004) "Product Information. Vitrase (hyaluronidase)." Bausch and Lomb Americas, Inc.
  2. (2023) "Product Information. Vyvgart Hytrulo (efgartigimod alfa-hyaluronidase)." argenx US Inc.

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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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