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a local anesthetic.
indications It is prescribed for caudal, epidural, peripheral, or sympathetic anesthetic block.
contraindications Known hypersensitivity to this drug or to any of the amide class of local anesthetics prohibits its use.
adverse effects Among the more serious adverse reactions are central nervous system disturbances, cardiovascular depression, respiratory arrest, cardiac arrest, and hypersensitivity reactions.
bupivacaine hydrochloride; Marcain prescription-only medicine local anaesthetic (maximum safe dosage for a 70-kg adult = 150 mg, equivalent to 2 mg/kg body weight); 0.25%, 0.5% and 0.75% solutions (equivalent to 2.5, 5.0 and 7.5 mg/mL respectively); cardiotoxicity and duration of action of plain solution = 4× that of lidocaine (i.e. 6-8 hours) (see Tables M3-M5); metabolized by liver and excreted by kidney; increases toxicity of other drugs (see Table 1); indicated for patients without a history of heart disease, where long-duration anaesthesia/pain control is required; contraindications and cautions are as those listed for lidocaine
|Local anaesthetic agent Proprietary name||Principal drug interactions||Effect of interaction|
|Increased myocardial depression|
Increased risk of ventricular arrhythmias if lidocaine is given with quinpristin/dalfopristin
Increased risk of ventricular arrhythmias if lidocaine is given with any drug that prolongs the QT interval of the cardiac cycle
Plasma concentration of lidocaine increased by amprenavir, atazanavir and lopinavir
Increased myocardial depression
Increased risk of lidocaine toxicity when given with propranolol
The action of lidocaine is antagonized by the hypokalaemia caused by acetazolamide, loop diuretics or thiazide and related diuretics (i.e. a greater dose of lidocaine would be required to achieve anaesthesia)
Increased risk of ventricular arrhythmia if lidocaine is given with dolasetron
Plasma concentration of lidocaine increased when given with cimetidine; risk of lidocaine toxicity increased with cimetidine
|Beta-blockers||Increased risk of bupivacaine toxicity when given with propranolol|
Increased risk of myocardial depression if given with other antiarrhythmic agents
|Increased risk of myocardial depression if given with antiarrhythmic agents|
Increased risk of methaemoglobinaemia if given with sulphonamide antibacterial agents
|Antidepressants||Metabolism of ropivacaine is inhibited by fluvoxamine, thereby enhancing the risk of ropivacaine toxicity|
|Drug not listed in the British National Formulary|
A local anaesthetic of the amide type used in eye surgery. It is used in 0.25-0.75% solution. It is often mixed with lidocaine hydrochloride. Its action starts after about 5 minutes and lasts for about 10 hours.
a local anesthetic used for peripheral nerve block, infiltration, and sympathetic, caudal or epidural block.