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Luvox and Ropivacaine Hydrochloride

Determining the interaction of Luvox and Ropivacaine Hydrochloride and the possibility of their joint administration.

Check result:

Luvox <> Ropivacaine Hydrochloride

Relevance: 04.03.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using ropivacaine together with fluvoxaMINE may increase the effects of ropivacaine. Contact your doctor if you experience restlessness, anxiety, incoherent speech, light-headedness, numbness and tingling of the mouth and lips, metallic taste, dizziness, blurred vision, tremors, twitching, depression, and drowsiness. If your doctor does prescribe these medications together, you may need a dose adjustment or special test 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.

Professional:

MONITOR: Coadministration with fluvoxamine may increase the plasma concentrations of ropivacaine. The mechanism is fluvoxamine inhibition of ropivacaine metabolism via CYP450 1A2. In twelve healthy volunteers, pretreatment with fluvoxamine (25 mg twice daily for 2 days) increased the mean total plasma clearance of ropivacaine (40 mg IV over 20 minutes) by 68% compared to administration of ropivacaine alone. In eight healthy volunteers, fluvoxamine (100 mg daily for 5 days) increased the area under the plasma concentration-time curve (AUC) of a single dose of ropivacaine (0.6 mg/kg IV over 30 minutes) by 3.7-fold compared to placebo. The ropivacaine AUC was further increased by 50% when fluvoxamine was given in combination with erythromycin (500 mg three times a day), presumably due to the additional inhibition of ropivacaine metabolism via CYP450 3A4. Fluvoxamine alone prolonged the elimination half-life of ropivacaine from 2.3 to 7.4 hours, while the addition of erythromycin further increased the half-life to 11.9 hours.

MANAGEMENT: Clinicians should recognize the potential for increased toxicity of ropivacaine during coadministration with fluvoxamine. The risk may be further increased by concomitant use of CYP450 3A4 inhibitors (e.g., itraconazole, ketoconazole, voriconazole, nefazodone, delavirdine, protease inhibitors, ketolide and certain macrolide antibiotics). Cardiovascular and respiratory vital signs and the patient's state of consciousness should be closely monitored. Restlessness, anxiety, incoherent speech, light-headedness, numbness and tingling of the mouth and lips, metallic taste, tinnitus, dizziness, blurred vision, tremors, twitching, depression, and drowsiness may be early warning signs of central nervous system toxicity.

References

McClure JH "Ropivacaine." Br J Anaesth 76 (1996): 300-7
"Product Information. Naropin (ropivacaine)." Astra USA, Westborough, MA.
Jokinen MJ, Ahonen J, Neuvonen PJ, Olkkola KT "The effect of erythromycin, fluvoxamine, and their combination on the pharmacokinetics of ropivacaine." Anesth Analg 91 (2000): 1207-12
Oda Y, Furuichi K, Tanaka K, Hiroi T, Imaoka S, Asada A, Fujimori M, Funae Y "Metabolism of a new local anesthetic, ropivacaine, by human hepatic cytochrome P450." Anesthesiology 82 (1995): 214-20
Halldin MM, Bredberg E, Angelin B, Arvidsson T, Askemark Y, Elofsson S, Widman M "Metabolism and excretion of ropivacaine in humans." Drug Metab Dispos 24 (1996): 962-8
Ekstrom G, Gunnarsson UB "Ropivacaine, a new amide-type local anesthetic agent, is metabolized by cytochromes P450 1A and 3A in human liver microsomes." Drug Metab Dispos 24 (1996): 955-61
Arlander E, Ekstrom G, Alm C, Carrillo JA, Bielenstein M, Bottiger Y, Bertilsson L, Gustafsson LL "Metabolism of ropivacaine in humans is mediated by CYP1A2 and to a minor extent by CYP3A4: An interaction study with fluvoxamine and ketoconazole as in vivo inhibitors." Clin Pharmacol Ther 64 (1998): 484-91

Luvox

Generic Name: fluvoxamine

Brand name: Luvox, Luvox CR

Synonyms: n.a.

What is Luvox?

Ropivacaine Hydrochloride

Generic Name: ropivacaine

Brand name: Naropin, Naropin Polyamp, Naropin SDV, Naropin Novaplus

Synonyms: Ropivacaine

What is Ropivacaine Hydrochloride?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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