Drug Interaction Report

Additional use of local anesthetics including prilocaine should generally be avoided within 96 hours following administration of BUPivacaine. Because the toxic effects of these medications are additive, using them together requires caution and constant monitoring of vital signs and state of consciousness to prevent serious and potentially life-threatening side effects such as methemoglobinemia (a condition that can deprive tissues and organs of oxygen), central nervous system reactions (e.G., convulsions, unconsciousness, coma, respiratory arrest), and cardiovascular disorders (e.G., low blood pressure, heart block, irregular heart rhythm, cardiac arrest). Patients require immediate medical attention if they develop signs and symptoms of methemoglobinemia such as pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Do not use alcohol or medications that contain alcohol while you are receiving treatment with HYDROmorphone. This may increase nervous system side effects such as drowsiness, dizziness, lightheadedness, difficulty concentrating, and impairment in thinking and judgment. In severe cases, low blood pressure, respiratory distress, fainting, coma, or even death may occur. If you are taking certain long-acting formulations of hydromorphone, consumption of alcohol may also cause rapid release of the drug, resulting in high blood levels that may be potentially lethal. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. Do not use more than the recommended dose of HYDROmorphone, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'local injectable anesthetics' category:

• bupivacaine / hydromorphone
• prilocaine

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.