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Intercurrent use: Exercise caution regarding toxic equivalence when mixtures of local anesthetics are employed.
CNS depressants: Use reduced doses when Local anesthetics are used in combination with CNS depressants.
CYP450: Dosage adjustment may be warranted when levobupivacaine is concurrently administered with enzyme inhibitors like CYP3A4 inhibitors (azole antimycotic such as ketoconazole, certain protease inhibitors such as ritonavir, macrolide antibiotics such as erythromycin, calcium channel antagonists such as verapamil) and CYP1A2 inhibitors (furafylline, clarithromycin), as systemic levobupivacaine levels may rise, resulting in toxicity.
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