Marcain Adrenaline Drug Interactions

Bupivacaine should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics, e.g. certain anti-arrhythmics, such as lidocaine and mexiletin since the systemic toxic effects are additive. Specific interaction studies with bupivacaine and anti-arrhythmic drugs class III (e.g. amiodarone) have not been performed, but caution should be advised.
Solutions containing adrenaline should be used with caution in those patients receiving drugs known to produce blood pressure alterations, i.e. MAO inhibitors, tricyclic antidepressants, phenothiazines, etc., as severe and sustained hypotension or hypertension may occur. The concurrent use of adrenaline-containing solutions and oxytocic drugs of the ergot type may cause severe, persistent hypertension and possibly cerebrovascular and cardiac accidents. Neuroleptics such as phenothiazines may oppose the vasoconstrictor effects of adrenaline giving rise to hypotensive responses and tachycardia.
Solutions containing adrenaline should be used with caution in patients undergoing general anaesthesia with inhalation agents such as halothane and enflurane, due to the risk of serious cardiac arrhythmias. Suitable beta-blockers should be immediately available and both hypoxia and hypercapnia should be avoided.
Non-selective beta-blockers such as propranolol enhance the pressor effects of adrenaline, which may lead to severe hypertension and bradycardia.