Drug Interactions between lidocaine / sodium bicarbonate and peppermint oil

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 and 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.

The following applies to enteric-coated, gastro-resistant formulations of peppermint oil (usually delayed or sustained release capsules):

Administration with food may disrupt the release mechanism of delayed or extended release formulations of peppermint oil by causing premature dissolution of the enteric coating in the stomach, resulting in early release of the peppermint oil. This can lead to gastrointestinal irritation such as heartburn, indigestion, nausea and vomiting, as well as reduced effectiveness of the medication. Enteric-coated, gastro-resistant formulations of peppermint oil should not be taken immediately after eating. These products should preferably be taken 30 to 90 minutes before a meal with water. The labeling for the specific product should be consulted for administration recommendations and other guidance. Talk to your doctor or pharmacist if you have questions on how to take peppermint oil or any of your other 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.

Consumer information for this interaction is not currently available.

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.