Drug General Information (ID: DDI38BIZDV)
Drug Name			Ropivacaine		Drug Info		Levobupivacaine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anesthetics				Anesthetics
Structure

Mechanism of Ropivacaine-Levobupivacaine Interaction (Severity Level: Moderate)
Increased risk of bradycardia Click to Show/Hide Mechanism Graph
Drug Name		Ropivacaine				Levobupivacaine
Mechanism 1		Bradycardia				Bradycardia
Key Mechanism Factor 1
		Factor Name		Bradycardia
		Factor Description		Bradycardia is a slow heart rate in which the heart beats less than 60 times per minute. If the heart rate is very slow and the heart is not pumping enough oxygen-rich blood to the body, and you may feel dizzy, very tired or weak, and short of breath.
Mechanism Description		Increased risk of bradycardia by the combination of Ropivacaine and Levobupivacaine
Increased risk of methemoglobinemia Click to Show/Hide Mechanism Graph
Drug Name		Ropivacaine				Levobupivacaine
Mechanism 2		Methemoglobinemia				Methemoglobinemia
Key Mechanism Factor 2
		Factor Name		Methemoglobinemia
		Factor Description		Methemoglobinemia is a condition in which higher than normal levels of methemoglobin are found in the blood. Methemoglobinemia is a potentially life-threatening condition in which the oxygen-carrying capacity of circulating hemoglobin is reduced due to the conversion of some or all of the four iron species from the reduced ferrous (Fe2+) state to the oxidized iron (Fe3+) state.
Mechanism Description		Increased risk of methemoglobinemia by the combination of Ropivacaine and Levobupivacaine

Recommended Action
Management		Use caution if these drugs are coadministered.

References
1	Product Information. Naropin (ropivacaine). Astra USA, Westborough, MA.