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Bupivacaine / ketamine / ketorolac and Alcohol/Food Interactions

There are 4 alcohol/food/lifestyle interactions with bupivacaine / ketamine / ketorolac which include:

Moderate

ketamine food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

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

GENERALLY AVOID: Coadministration of oral ketamine with grapefruit juice may significantly increase the plasma concentrations of S(+) ketamine, the dextrorotatory enantiomer of ketamine. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. When a single 0.2 mg/kg dose of S(+) ketamine was administered orally on study day 5 with grapefruit juice (200 mL three times daily for 5 days) in 12 healthy volunteers, mean S(+) ketamine peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 2.1- and 3.0-fold, respectively, compared to administration with water. In addition, the elimination half-life of S(+) ketamine increased by 24% with grapefruit juice, and the ratio of the main metabolite norketamine to ketamine was decreased by 57%. The pharmacodynamics of ketamine were also altered by grapefruit juice. Specifically, self-rated relaxation was decreased and performance in the digit symbol substitution test was increased with grapefruit juice, but other behavioral or analgesic effects were not affected.

MANAGEMENT: Patients receiving ketamine should not drink alcohol. Caution is advised when ketamine is used in patients with acute alcohol intoxication or a history of chronic alcoholism. Following anesthesia with ketamine, patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination, such as driving or operating hazardous machinery, for at least 24 hours and until they know how the medication affects them. Patients treated with oral ketamine should also avoid consumption of grapefruit and grapefruit juice during treatment. Otherwise, dosage reductions of oral ketamine should be considered.

References

  1. Peltoniemi MA, Saari TI, Hagelberg NM, Laine K, Neuvonen PJ, Olkkola KT "S-ketamine concentrations are greatly increased by grapefruit juice." Eur J Clin Pharmacol 68 (2012): 979-86
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. "Product Information. Ketalar (ketamine)." JHP Pharmaceuticals, Saddle River, NJ.
View all 4 references
Major

High Blood Pressure (Hypertension)

Major Potential Hazard, Moderate plausibility

ketamine - hypertension

The use of ketamine is contraindicated in patients whom a significant elevation of blood pressure would constitute a serious hazard. It is recommended to monitor cardiac function continually during a procedure in patients with hypertension or cardiac decompensation.

Major

High Blood Pressure (Hypertension)

Major Potential Hazard, Moderate plausibility

NSAIDs - fluid retention

Fluid retention and edema have been reported in association with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure. Blood pressure and cardiovascular status should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

References

  1. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A "NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics." Arch Intern Med 158 (1998): 1108-12
  3. Agnholt J, Andreasen F "The effect of ibuprofen therapy on water and electrolyte balance." Acta Med Scand 212 (1982): 65-9
  4. Johnson AG, Nguyen TV, Day RO "Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis." Ann Intern Med 121 (1994): 289-300
  5. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Celebrex (celecoxib)." Searle, Chicago, IL.
  7. "Product Information. Nalfon (fenoprofen)." Xspire Pharma, Ridgeland, MS.
  8. "Product Information. Anaprox (naproxen)." Roche Laboratories, Nutley, NJ.
  9. "Product Information. Feldene (piroxicam)." Pfizer US Pharmaceuticals, New York, NY.
  10. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  11. Lewis RV, Toner JM, Jackson PR, Ramsay LE "Effects of indomethacin and sulindac on blood pressure of hypertensive patients." Br Med J 292 (1986): 934-5
  12. Gurwitz JH, Everitt DE, Monane M, et al "The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons." J Gerontol A Biol Sci Med Sci 51 (1996): m74-9
  13. "Product Information. Mobic (meloxicam)" Boehringer-Ingelheim, Ridgefield, CT.
  14. "Product Information. Daypro (oxaprozin)." Searle, Skokie, IL.
  15. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn, Kalamazoo, MI.
  16. Van Den Ouweland FA, Gribnau FW, Meyboom RH "Congestive heart failure due to nonsteroidal anti-inflammatory drugs in the elderly." Age Ageing 17 (1988): 8-16
  17. Heynen G "Toleration and safety of piroxicam." Eur J Rheumatol Inflamm 8 (1987): 86-93
  18. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc, Palo Alto, CA.
  19. "Product Information. Vioxx (rofecoxib)." Merck & Co, Inc, West Point, PA.
  20. Easton PA, Koval A "Hypertensive reaction with sulindac." Can Med Assoc J 122 (1980): 1273-4
  21. Brooks CD, Linet OI, Schellenberg D, Turner LF, Defesche CL, Teoh KW, Johnson JH, Assenzo JR "Clinical safety of flurbiprofen." J Clin Pharmacol 30 (1990): 342-51
  22. Petersson I, Nilsson G, Hansson B-G, Hedner T "Water intoxication associated with non-steroidal anti-inflammatory drug therapy." Acta Med Scand 221 (1987): 221-3
  23. Buckley MM, Brogden RN "Ketorolac. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential." Drugs 39 (1990): 86-109
  24. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical, Raritan, NJ.
  25. "Product Information. Relafen (nabumetone)." SmithKline Beecham, Philadelphia, PA.
  26. "Product Information. Bextra (valdecoxib)." Pharmacia Corporation, Peapack, NJ.
  27. Willkens RF "Worldwide clinical safety experience with diclofenac." Semin Arthritis Rheum 2 Suppl 1 (1985): 105-10
  28. "Product Information. Clinoril (sulindac)." Merck & Co, Inc, West Point, PA.
  29. "Product Information. Indocin (indomethacin)." Merck & Co, Inc, West Point, PA.
View all 29 references
Moderate

High Blood Pressure (Hypertension)

Moderate Potential Hazard, Moderate plausibility

NSAIDs - hypertension

NSAIDs including topicals can lead to the onset of new hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. Blood pressure should be monitored closely during NSAID therapy and throughout the course of therapy.

Bupivacaine / ketamine / ketorolac drug interactions

There are 754 drug interactions with bupivacaine / ketamine / ketorolac

Bupivacaine / ketamine / ketorolac disease interactions

There are 17 disease interactions with bupivacaine / ketamine / ketorolac which include:

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.