Drug General Information (ID: DDIU0F8A2Z)
Drug Name			Bupivacaine		Drug Info		Prilocaine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anesthetics				Anesthetics
Structure

Mechanism of Bupivacaine-Prilocaine Interaction (Severity Level: Major)
Increased risk of methemoglobinemia Click to Show/Hide Mechanism Graph
Drug Name		Bupivacaine				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 Bupivacaine 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	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Product Information. Zynrelef (bupivacaine-meloxicam). Heron Therapeutics, Redwood City, CA.