Drug General Information (ID: DDI6SIAOP4)
  Drug Name Flutamide Drug Info Prilocaine Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antineoplastics Anesthetics
  Structure

 Mechanism of Flutamide-Prilocaine Interaction (Severity Level: Major)
     Increased risk of methemoglobinemia Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Flutamide Prilocaine
      Mechanism Methemoglobinemia Methemoglobinemia
      Key Mechanism Factor 1
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 Flutamide and Prilocaine 

Recommended Action
      Management Prilocaine should be used with caution in the presence of other methemoglobin-inducing drugs. Patients should be closely monitored to ensure adequate perfusion and oxygenation during treatment with prilocaine. Methemoglobin levels should be monitored and oxygen administered whenever possible. Signs and symptoms of methemoglobinemia may be delayed some hours after drug exposure. Patients or their caregivers should be advised to seek medical attention if they notice signs and symptoms of methemoglobinemia such as slate-grey cyanosis in buccal mucous membranes, lips, and nail beds nausea headache dizziness lightheadedness lethargy fatigue dyspnea tachypnea tachycardia palpitation anxiety and confusion.

References
1 Agencia Espaola de Medicamentos y Productos Sanitarios Healthcare "Centro de informacion online de medicamentos de la AEMPS - CIMA.".
2 Cerner Multum, Inc. "Australian Product Information.".
3 Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4 Guay J "Methemoglobinemia related to local anesthetics: a summary of 242 episodes." Anesth Analg 108 (2009): 837-45. [PMID: 19224791]
5 Product Information. Citanest Forte (epinephrine-prilocaine) Astra-Zeneca Pharmaceuticals, Wilmington, DE.
6 Product Information. Citanest Plain (prilocaine) Astra-Zeneca Pharmaceuticals, Wilmingtoon, DE.
7 Skold A, Cosco DL, Klein R "Methemoglobinemia: pathogenesis, diagnosis, and management." South Med J 104 (2011): 757-61. [PMID: 22024786]