Drug Interaction Report
1 potential interaction and/or warning found for the following 2 drugs:
- bupivacaine
- Bystolic (nebivolol)
Interactions between your drugs
BUPivacaine nebivolol
Applies to: bupivacaine, Bystolic (nebivolol)
MONITOR: Beta-blockers may increase the risk of bupivacaine-induced side effects. The proposed mechanism is increased bupivacaine levels due to hepatic enzyme inhibition (propranolol) and/or additive negative inotropic effects on the heart. Patients with heart failure may be at a greater risk. Data have been conflicting and variable. Theoretically, beta-blocker ophthalmic solutions may also interact, as they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.
MANAGEMENT: Caution is recommended if multiple doses of bupivacaine are administered in the presence of a beta-blocker. Monitoring for drowsiness, mental status changes, convulsions, ECG changes, and hypotension is advisable during concurrent therapy.
References (3)
- Roitman K, Sprung J, Wallace M, Matjasko J (1993) "Enhancement of bupivacaine cardiotoxcity with cardiac glycosides and beta-adrenergic blockers: a case report." Anesth Analg, 76, p. 658-61
- Ponten J, Biber B, Bjuro T, Henriksson BA, Hjalmarson A, Lundberg D (1982) "Beta-receptor blockade and spinal anaesthesia. Withdrawal versus continuation of long-term therapy." Acta Anaesthesiol Scand Suppl, 76, p. 62-9
- Ponten J, Biber B, Henriksson BA, Jonsteg C (1982) "Bupivacaine for intercostal nerve blockade in patients on long-term beta-receptor blocking therapy." Acta Anaesthesiol Scand Suppl, 76, p. 70-7
Drug and food interactions
No alcohol/food interactions were found with the drugs in your list. However, this does not necessarily mean no food interactions exist. Always consult your healthcare provider.
Therapeutic duplication warnings
No duplication 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
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
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Further information
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