Drug Interaction Report
3 potential interactions and/or warnings found for the following 2 drugs:
- bupivacaine / epinephrine
- hyaluronidase / nivolumab
Interactions between your drugs
EPINEPHrine hyaluronidase
Applies to: bupivacaine / epinephrine, hyaluronidase / nivolumab
GENERALLY AVOID: Hyaluronidase may enhance the absorption and dispersion of dopamine and/or other injectable alpha agonist drugs, resulting in cardiovascular effects such as increased blood pressure, increased vascular resistance and other alpha adrenergic-mediated adverse effects. Hyaluronidase is a dispersion agent, that can increase the permeability of connective tissue through the hydrolysis of hyaluronic acid. There are no clinical data available for this interaction.
MANAGEMENT: The manufacturer of hyaluronidase recommends avoiding the use of hyaluronidase to enhance the absorption and dispersion of dopamine and/or alpha agonist drugs. Some authorities consider this particular use of hyaluronidase as contraindicated. However, hyaluronidase used for other indications, may be administered to patients receiving dopamine and/or alpha agonist drugs. Consultation with product labeling and local or institutional guidelines may be appropriate for further recommendations.
References (6)
- (2018) "Product Information. Hylenex (hyaluronidase)." Halozyme Therapeutics
- (2024) "Product Information. Vitrase (hyaluronidase)." Bausch and Lomb Americas, Inc.
- (2024) "Product Information. Amphadase (hyaluronidase)." Amphastar Pharmaceuticals Inc
- (2015) "Product Information. Hyalase (hyaluronidase)." Wockhardt UK Ltd
- (2024) "Product Information. Hyalase (hyaluronidase)." Sanofi-Aventis Australia Pty Ltd
- king m, Convery C, davies e (2018) "This month's guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4)" J Clin Aesthet Dermatol, 11, p. 61-68
BUPivacaine hyaluronidase
Applies to: bupivacaine / epinephrine, hyaluronidase / nivolumab
When hyaluronidase is added to a local anesthetic, the local anesthetic solution undergoes increased absorption, resulting in a shorter duration of action and possible increased frequency of systemic reactions. The clinical significance is unknown. It may be advisable to monitor the patient for altered anesthetic efficacy and side effects.
References (2)
- (2004) "Product Information. Vitrase (hyaluronidase)." Bausch and Lomb Americas, Inc.
- (2023) "Product Information. Vyvgart Hytrulo (efgartigimod alfa-hyaluronidase)." argenx US Inc.
Drug and food interactions
EPINEPHrine food
Applies to: 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)
- 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
- 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
- (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
- (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
- (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
- (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
- (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
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.
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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