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Drug Interactions between Lets Gel Kit and propranolol

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

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Interactions between your drugs

Moderate

propranolol EPINEPHrine topical

Applies to: propranolol and Lets Gel Kit (epinephrine / lidocaine / tetracaine topical)

MONITOR: Coadministration of non-cardioselective beta-blockers, such as propranolol, with topical solutions containing epinephrine may enhance the hypertensive effect of epinephrine, which may increase the risk of cardiac arrest and hypertensive stroke. The mechanism of this interaction involves beta-blocker antagonism of epinephrine's beta-agonist effects which results in unopposed alpha-stimulated vasoconstriction and reflexive decreases in heart rate. Epinephrine vascular clearance may also be reduced by concomitant beta-blocker use. Following administration of intravenous, local, or subcutaneous epinephrine, patients receiving propranolol have experienced hypertensive reactions, including life-threatening reactions, and often accompanied by bradycardia and/or arrhythmias. Numerous clinical studies have demonstrated significant increases in blood pressure (i.e., 20 to 40 mmHg) and vascular resistance, and decreases in heart rate, in patients receiving non-cardioselective beta-blockers with epinephrine. There are numerous case reports of patients taking propranolol who developed severe hypertension after local infiltration of lidocaine mixed with epinephrine, including one patient who went into cardiac arrest. Theoretically, when a topical solution containing epinephrine is used with local anesthetics to provide pain relief for wound closure, it is possible for a sufficient amount of epinephrine to be absorbed through the skin, particularly via wounds or lacerations, to cause systemic effects; however data are lacking.

MANAGEMENT: Caution and close monitoring of cardiovascular status (i.e., blood pressure, heart rate) are recommended when topical solutions containing epinephrine are administered to patients treated with non-cardioselective beta-blockers. Some authorities recommend avoiding treatment with topical solutions containing epinephrine (AU; Laceraine Topical Wound Anaesthetic(R)) in patients receiving a non-cardioselective beta-blocker.

References

  1. Gandy W (1989) "Severe epinephrine-propanolol interaction." Ann Emerg Med, 18, p. 98-9
  2. Houben H, Thien T, De Boo T, Lemmens W, Van Herwaarden CL, Fennis JF, Van 't Laar A (1979) "Influence of selective and non-selective beta-adrenoreceptor blockade on the haemodynamic effect of adrenaline during combined antihypertensive drug therapy." Clin Sci, 57, s397-9
  3. van Herwaarden CL, Binkhorst RA, Fennis JF, van 't Laar A (1977) "Effects of adrenaline during treatment with propranolol and metoprolol." Br Med J, 2, p. 1029
  4. Houben H, Thien TH, De Boo TH, et al. (1979) "Influence of selective and non-selective beta-adrenoceptor blockade on the haemodynamic effect of adrenaline during combined antihypertensive drug therapy." Clin Sci, 57, s397-9
  5. Foster CA, Aston SJ (1983) "Propranolol-epinephrine interaction: a potential disaster." Plast Reconstr Surg, 72, p. 74-8
  6. Ichinohe T, Igarashi O, Kaneko Y (1991) "The influence of propranolol on the cardiovascular effects and plasma clearance of epinephrine." Anesth Prog, 38, p. 217-20
  7. Cerner Multum, Inc. "Australian Product Information."
View all 7 references

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Drug and food interactions

Moderate

propranolol food

Applies to: propranolol

ADJUST DOSING INTERVAL: The bioavailability of propranolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take propranolol at the same time each day, preferably with or immediately following meals.

References

  1. Olanoff LS, Walle T, Cowart TD, et al. (1986) "Food effects on propranolol systemic and oral clearance: support for a blood flow hypothesis." Clin Pharmacol Ther, 40, p. 408-14
  2. Byrne AJ, McNeil JJ, Harrison PM, Louis W, Tonkin AM, McLean AJ (1984) "Stable oral availability of sustained release propranolol when co-administered with hydralazine or food: evidence implicating substrate delivery rate as a determinant of presystemic drug interactions." Br J Clin Pharmacol, 17, s45-50

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Moderate

propranolol food

Applies to: propranolol

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. 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

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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.

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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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