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Clonidine/epinephrine/ketorolac/ropivacaine and Alcohol/Food Interactions

There are 6 alcohol/food/lifestyle interactions with clonidine / epinephrine / ketorolac / ropivacaine.

Moderate

EPINEPHrine Caffeine

Moderate Drug Interaction

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

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

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Minor

Caffeine ROPivacaine

Minor Drug Interaction

Ropivacaine serum concentrations may increase when given with drugs metabolized by the CYP450 isoenzyme 1A2. The theorized mechanism is via competitive inhibition. Information is only available from in-vitro studies. The clinical significance is unknown. Consider monitoring the patient more closely for prolonged or excessive ropivacaine effects if these agents are coadministered.

References

  1. "Product Information. Naropin (ropivacaine)." Astra-Zeneca Pharmaceuticals PROD (2001):

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Moderate

cloNIDine Alcohol (Ethanol)

Moderate Drug Interaction

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Moderate

ketorolac Alcohol (Ethanol)

Moderate Drug Interaction

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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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. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):
  2. "Product Information. Nalfon (fenoprofen)." Xspire Pharma PROD (2002):
  3. "Product Information. Indocin (indomethacin)." Merck & Co., Inc PROD (2002):
  4. "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories PROD (2002):
  5. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc PROD (2002):
  6. "Product Information. Anaprox (naproxen)." Roche Laboratories PROD (2006):
  7. "Product Information. Clinoril (sulindac)." Merck & Co., Inc PROD (2001):
  8. "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical PROD (2001):
  9. "Product Information. Relafen (nabumetone)." SmithKline Beecham PROD (2001):
  10. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals PROD (2001):
  11. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn PROD (2001):
  12. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories PROD (2001):
  13. "Product Information. Daypro (oxaprozin)." Searle PROD (2001):
  14. "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim PROD (2001):
View all 14 references
Moderate

High Blood Pressure (Hypertension)

Moderate Potential Hazard, Moderate plausibility

NSAIDs - hypertension

Nonsteroidal anti-inflammatory drugs (NSAIDs), including topicals, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which can contribute to the increased incidence of cardiovascular events. NSAIDs should be used with caution in patients with hypertension. Blood pressure should be monitored closely during the initiation of NSAID therapy and throughout the course of therapy.

References

  1. "Product Information. Indocin (indomethacin)." Merck & Co., Inc PROD (2002):
  2. "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc PROD (2002):
  3. "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals PROD (2001):
  4. "Product Information. Relafen (nabumetone)." SmithKline Beecham PROD (2001):
  5. "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals PROD (2001):
  6. "Product Information. Dolobid (diflunisal)." Merck & Co., Inc PROD (2001):
  7. "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn PROD (2001):
  8. "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories PROD (2001):
  9. "Product Information. Daypro (oxaprozin)." Searle PROD (2001):
  10. "Product Information. Celebrex (celecoxib)." Searle PROD (2001):
  11. "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc (2012):
  12. "Product Information. Flector Patch (diclofenac topical)." Actavis U.S. (Alpharma USPD) (2016):
View all 12 references

Clonidine/epinephrine/ketorolac/ropivacaine drug interactions

There are 919 drug interactions with clonidine / epinephrine / ketorolac / ropivacaine.

Clonidine/epinephrine/ketorolac/ropivacaine disease interactions

There are 23 disease interactions with clonidine / epinephrine / ketorolac / ropivacaine which include:

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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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