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Drug Interactions between metipranolol ophthalmic and Raphon

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

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Moderate

metipranolol ophthalmic EPINEPHrine topical

Applies to: metipranolol ophthalmic and Raphon (epinephrine 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

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

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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.

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