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Drug Interactions between milnacipran and Sensorcaine-MPF with Epinephrine

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

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Interactions between your drugs

Moderate

EPINEPHrine milnacipran

Applies to: Sensorcaine-MPF with Epinephrine (bupivacaine / epinephrine) and milnacipran

MONITOR: Additive or synergistic effects on blood pressure and heart rate may occur when serotonin-norepinephrine reuptake inhibitors (SNRIs) such as milnacipran are combined with the sympathomimetic agents norepinephrine or epinephrine. The proposed mechanism is increased noradrenergic response due to SNRI-mediated inhibition of the reuptake of these sympathomimetics into the sympathetic nerve fibre. The use of milnacipran alone has also been associated with rare cases of sustained tachycardia, hypertension, and reversible cardiomyopathy requiring treatment discontinuation.

MANAGEMENT: Caution is advised if SNRIs are used with other drugs that can increase blood pressure and/or heart rate. Blood pressure and pulse should be measured prior to initiating SNRI therapy and monitored at regular intervals thereafter. Dose reduction or discontinuation of the SNRI should be considered in patients who experience a sustained increase in blood pressure or pulse rate. Some authorities advise that if the hemostatic action of epinephrine via subcutaneous or gingival injection is needed in adults, an epinephrine dose of less than 0.1 mg in 10 minutes or 0.3 mg in an hour may be considered.

References (5)
  1. Cerner Multum, Inc. "Australian Product Information."
  2. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
  3. Yoshida K, Higuchi H, Takahashi H, Shimizu T (2002) "Elevation of blood pressure induced by high-dose milnacipran." Hum Psychopharmacol, 17, p. 431
  4. Palmer RH, Periclou A, Banerjee P (2010) "Milnacipran: a selective serotonin and norepinephrine dual reuptake inhibitor for the management of fibromyalgia" Ther Adv Musculoskelet Dis, 2, p. 201-20
  5. Forman MB, Sutej PG, Jackson EK (2011) "Hypertension, tachycardia, and reversible cardiomyopathy temporally associated with milnacipran use." Tex Heart Inst J, 38, p. 714-8

Drug and food interactions

Moderate

milnacipran food

Applies to: milnacipran

GENERALLY AVOID: Use of milnacipran in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Milnacipran alone can increase serum transaminase levels. In placebo-controlled fibromyalgia trials, increases in ALT were more frequently observed in patients treated with milnacipran 100 mg/day (6%) and 200 mg/day (7%) compared to patients treated with placebo (3%). One patient receiving milnacipran 100 mg/day (0.2%) had an increase in ALT greater than 5 times the upper limit of normal (ULN) but did not exceed 10 times the ULN. Increases in AST were also more frequently observed in patients treated with milnacipran 100 mg/day (3%) and 200 mg/day (5%) than in patients treated with placebo (2%). There have been reported cases of increased liver enzymes and severe liver injury, including fulminant hepatitis, from foreign postmarketing experience with milnacipran. Significant underlying clinical conditions and/or use of multiple concomitant medications were present in the cases of severe liver injury.

MANAGEMENT: Due to the risk of liver injury, patients prescribed milnacipran should be counseled to avoid excessive use of alcohol. Milnacipran should generally not be prescribed to patients with substantial alcohol use.

References (1)
  1. (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
Moderate

EPINEPHrine food

Applies to: Sensorcaine-MPF with Epinephrine (bupivacaine / epinephrine)

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.

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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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