Interactions : אינטראקציות

4.5 Interactions with other medicinal products and other forms of interaction
Ropivacaine should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics, e.g. certain antiarrhythmics, such as lidocaine and mexiletine, since the systemic toxic effects are additive. Simultaneous use of Ropivacaine with general anaesthetics or opioids may potentiate each others (adverse) effects. Specific interaction studies with ropivacaine and anti-arrhythmic active substances class III (e.g., amiodarone) have not been performed, but caution is advised (See also section 4.4).
Cytochrome P450 (CYP) 1A2 is involved in the formation of 3-hydroxy ropivacaine, the major metabolite. In vivo the plasma clearance of ropivacaine was reduced by up to 77% during coadministration of fluvoxamine, a selective, potent and competitive CYP1A2 inhibitor. Thus strong inhibitors of CYP1A2, such as fluvoxamine and enoxacin, given concomitantly during prolonged administration of Ropivacaine, can interact with Ropivacaine. Prolonged administration of ropivacaine should be avoided in patients concomitantly treated with strong CYP1A2 inhibitors. (See also section 4.4).
In vivo the plasma clearance of ropivacaine was reduced by 15 % during coadministration of ketoconazole, a selective and potent inhibitor of CYP3A4. However the inhibition of this isozyme is not likely to have clinical relevance.
In vitro ropivacaine is a competitive inhibitor of CYP2D6 but does not seem to inhibit this isozyme at clinically attained plasma concentrations.