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Drug Interactions between propofol and Raxar

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

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Interactions between your drugs

Moderate

propofol grepafloxacin

Applies to: propofol and Raxar (grepafloxacin)

MONITOR: Treatment with propofol may lead to prolongation of the QT interval; however, the extent of prolongation and its clinical impact is difficult to determine. A retrospective single-center cohort study in patients treated at the Mayo clinic over 17 years (n=628,784) concluded that torsade de pointes (TdP) after propofol administration occurred at an annual incidence of 1.93 per million; however, it was often associated with other risk factors, including concomitant QT-prolonging medications, low serum potassium levels (<3.5 mmol/L), and low serum magnesium levels (<1.8 mg/dL). Other studies have reported that propofol has no effect or that it decreases the QTc interval and may offset QTc prolongation due to other coadministered anesthetic medications. Theoretically, concurrent use of two or more drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias including TdP and sudden death. The risk of an individual agent or a combination of these agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drugs. Data from formal QT/QTc studies on propofol are lacking.

MANAGEMENT: Caution and clinical monitoring is recommended if propofol is used concomitantly with other agents associated with QT interval prolongation. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References

  1. Whyte SD, Booker PD, Buckley DG "The Effects of Propofol and Sevoflurane on the QT Interval and Transmural Dispersion of Repolarization in Children." Anesth Analg 100 (2005): 71-77
  2. Staikou C, Stamelos M, Stavroulakis E "Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity." Br J Anaesth 112 (2014): 217-30
  3. Toyoda T, Terao Y, Oji M, Okada M, Fukusaki M, Sumikawa K "The interaction of antiemetic dose of droperidol with propofol on QT interval during anesthetic induction." J Anesth 27 (2013): 885-9
  4. Wutzler A, De Asmundis C, Matsuda H, et al. "Effects of propofol on ventricular repolarization and incidence of malignant arrhythmias in adults." J Electrocardiol 51 (2018): 170-4
  5. Kim DH, Kweon TD, Nam SB, Han DW, Cho WY, Lee JS "Effects of target concentration infusion of propofol and tracheal intubation on QTc interval." Anaesthesia 63 (2008): 1061-4
  6. Scalese MJ, Herring HR, Rathburn RC, Skrepnek GH, Ripley TL "Propofol-associated QTc prolongation." Ther Adv Drug Saf 7 (2016): 68-78
  7. Hanci V, Aydin M, Yurtlu BS, et al. "Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals." Kaohsiung J Med Sci 26 (2010): 470-7
  8. Kleinsasser A, Kuenszberg E, Loeckinger A, et al. "Sevoflurane, but not propofol, significantly prolongs the Q-T interval." Anesth Analg 90 (2000): 25-7
  9. Paventi S, Santevecchi A, Ranieri R "Effects of sevoflurane versus propofol on QT interval." Minerva Anestesiol 67 (2001): 637-40
  10. Kleinsasser A, Loeckinger A, Lindner KH, Keller C, Boehler M, Puehringer F "Reversing sevoflurane-associated Q-Tc prolongation by changing to propofol." Anaesthesia 56 (2001): 248-50
View all 10 references

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Drug and food interactions

Moderate

propofol food

Applies to: propofol

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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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.

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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