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Drug Interaction Report

11 potential interactions and/or warnings found for the following 2 drugs:

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Interactions between your drugs

Major

lidocaine ROPivacaine

Applies to: betamethasone / iodixanol / lidocaine, clonidine / epinephrine / ketorolac / ropivacaine

Using lidocaine together with ROPivacaine may cause methemoglobinemia, a rare condition that can lead to oxygen deprivation in tissues and vital organs due to reduced oxygen-carrying capacity of the blood. Individuals may be more susceptible to developing methemoglobinemia during treatment with these medications if they are very young (especially neonates and infants) or have diseases of the heart or lungs, certain genetic predispositions, or glucose-6-phosphate dehydrogenase deficiency. Close medical supervision is necessary when medications that can cause methemoglobinemia are used together. Signs and symptoms of methemoglobinemia may occur immediately or hours after treatment. Using lidocaine together with ROPivacaine may also affect the rhythm of your heart. Contact your doctor if you experience chest pain, palpitations, nausea, vomiting, lightheadedness, nervousness, dizziness, or tremors. Patients or their caregivers should seek immediate medical attention if they develop gray discoloration of the skin, abnormal blood coloration, nausea, headache, dizziness, lightheadedness, fatigue, shortness of breath, rapid or shallow breathing, a rapid heartbeat, palpitation, anxiety, or confusion. 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.

Major

ketorolac iodixanol

Applies to: clonidine / epinephrine / ketorolac / ropivacaine, betamethasone / iodixanol / lidocaine

Before you undergo any imaging procedure where iodixanol may be given by injection, let your doctor know if you are currently being treated with ketorolac. Injection of iodixanol and similar contrast agents can sometimes cause kidney damage, and combining it with other medications that can also affect the kidney such as ketorolac may increase that risk. If you have been receiving ketorolac, your doctor may need to take special precautionary measures before, during and after the contrast injection, particularly if you also have other risk factors such as diabetes, preexisting kidney problems, dehydration, old age, congestive heart failure, low blood pressure, anemia, and multiple myeloma. Alternatively, if the risk is too great, your doctor may choose to perform a different imaging procedure where injection of a contrast is not needed. Following the procedure, you should drink plenty of fluids to keep yourself hydrated and to help flush the contrast agent out of your kidneys. Seek medical attention if you develop signs and symptoms that may suggest kidney damage such as nausea, vomiting, loss of appetite, increased or decreased urination, sudden weight gain or weight loss, fluid retention, swelling, shortness of breath, muscle cramps, tiredness, weakness, dizziness, confusion, and irregular heart rhythm. 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.

Moderate

cloNIDine betamethasone

Applies to: clonidine / epinephrine / ketorolac / ropivacaine, betamethasone / iodixanol / lidocaine

Betamethasone may reduce the effects of cloNIDine in lowering blood pressure. The interaction is most likely to occur when betamethasone is used for more than a week, since prolonged use can cause sodium and water retention. Let your doctor know if you experience sudden, unexplained weight gain or swelling of the hands, ankles, or feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. 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.

Moderate

ketorolac betamethasone

Applies to: clonidine / epinephrine / ketorolac / ropivacaine, betamethasone / iodixanol / lidocaine

Using betamethasone together with ketorolac may increase the risk of side effects in the gastrointestinal tract such as inflammation, bleeding, ulceration, and rarely, perforation. Gastrointestinal perforation is a potentially fatal condition and medical emergency where a hole forms all the way through the stomach or intestine. You should take these medications with food to lessen the risk. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Your doctor may also be able to recommend medications to help protect the stomach and intestine if you are at high risk for developing serious gastrointestinal complications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. 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.

Minor

cloNIDine lidocaine

Applies to: clonidine / epinephrine / ketorolac / ropivacaine, betamethasone / iodixanol / lidocaine

Information for this minor interaction is available on the professional version.

Drug and food interactions

Moderate

lidocaine food

Applies to: betamethasone / iodixanol / lidocaine

Grapefruit juice may increase the blood levels of lidocaine, which may increase the risk of side effects such as low blood pressure, slow heart rate, irregular heart rhythm, difficulty breathing and convulsions. Cigarette smoking may reduce the blood levels of lidocaine, which may make the medication less effective. It is best to avoid smoking during lidocaine therapy. Consuming cruciferous vegetables (e.G., broccoli, brussels sprouts) may also reduce the blood levels of lidocaine. Talk to a healthcare professional if you have any questions or concerns. 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.

Moderate

cloNIDine food

Applies to: clonidine / epinephrine / ketorolac / ropivacaine

CloNIDine and ethanol (alcohol) may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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.

Moderate

ketorolac food

Applies to: clonidine / epinephrine / ketorolac / ropivacaine

Ask your doctor before using ketorolac together with ethanol (alcohol). Do not drink alcohol while taking ketorolac. Alcohol can increase your risk of stomach bleeding caused by ketorolac. Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds. 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.

Moderate

EPINEPHrine food

Applies to: clonidine / epinephrine / ketorolac / ropivacaine

Both EPINEPHrine and caffeine can increase blood pressure and heart rate, and combining them may enhance these effects. Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. 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.

Moderate

lidocaine food

Applies to: betamethasone / iodixanol / lidocaine

Consumer information for this interaction is not currently available.

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Local injectable anesthetics

Therapeutic duplication

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:

  • betamethasone / iodixanol / lidocaine
  • clonidine / epinephrine / ketorolac / ropivacaine

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.


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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.

See also:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.