Lidocaine Barbiturates

Lopinavir/Ritonavir (Kaletra) [Anrirelroviral/Protease Inhibitor] Uses HIV Infxn Action Protease inhibitor Dose Adults. Tx naive 2 tab PO daily or 1 tab PO bid Tx experiencedpt 1 tab PO bid (T dose if w/ amprenavir, efavirenz, fosamprenavir, nelfinavir, nevirapine) Peds. 7-15 kg 12/3 mg/kg PO bid 15-40 kg 10/2.5 mg/kg PO bid >40 kg Adult dose w/ food Caution [C, /-] Numerous interactions Contra w/drugs dependent on CYP3A/CYP2D6 (Table VI-8) Disp Tab, soln SE Avoid disulfiram (soln has EtOH), metronidazole GI upset, asthenia, T cholesterol/triglycerides, pancreatitis protease metabolic synd Interactions T Effects Wl clarithromycin, erythromycin T effects OF amiodarone, amprenavir, azole andfungals, bepridil, cisapride, cyclosporine, CCBs, ergot alkaloids, flecainide, flurazepam, HMG-CoA reductase inhibitors, indinavir, lidocaine, meperidine, midazolam, pimozide, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, tacrolimus, terfenadine, triazolam, zolpidem 1 effects Wl barbiturates, carbamazepine, dexamethasone, didanosine, efavirenz, nevirapine, phenytoin, rifabutin, rifampin, St. John s wort 1 effects OF OCPs, warfarin EMS Use andarrhythmics and benzodiazepines... 

A4 Acetaminophen, alfentanil, amiodarone, astemizole, cocaine, cortisol, cyclosporine, dapsone, diazepam, dihydroergotamine, dihydropyridines, diltiazem, ethinyl estradiol, gestodene, indinavir, lidocaine, lovastatin, macrolides, methadone, miconazole, midazolam, mifepristone (RU 486), paclitaxel, progesterone, quinidine, rapamycin, ritonavir, saquinavir, spironolactone, sulfamethoxazole, sufentanil, tacrolimus, tamoxifen, terfenadine, testosterone, tetrahydro-cannabinol, triazolam, troleandomycin, verapamil Barbiturates, carbamazepine, macrolides, glucocorticoids, pioglitazone, phenytoin, rifampin Erythromycin, 613-hydroxy cortisol... 

Simultaneous alimemazine, amitriptyline, amphetamine, bupivacaine, buprenorphine, clomipramine, cocaine, codeine, ethylmorphine, glafenine, meperidine, methampheta-mine, methotrimeprazine, morphine, norcodeine, nortriptyline, pentazocine Noninterfering acetaminophen, aspirin, barbiturates, benzoylecgonine, caffeine, diazepam, flunitrazepam, lidocaine, lorazepam, nalorphine, naloxone, nitrazepam, nordiaze-pam, norflunitrazepam, normorphine, oxazepam, prazepam, triazolam, zolpidem Interfering cyamemazine, desipramine, imipramine... 

Furthermore, nonester-type drugs, especially lidocaine derivatives, also are known to be more prone to enzyme induction or inhibition of other medications (e.g., cimetidine and barbiturates). 

Plasma lidocaine levels following slow intravenous injection may be modestly lower in patients who are taking barbiturates. 

Not fully understood. One suggestion is that the barbiturates increase the activity of the liver microsomal enzymes, thereby increasing the rate of metabolism of the lidocaine. ... 

Direct information is very limited. It may be necessary to increase the dosage of lidocaine to achieve the desired therapeutic response in patients on phenobarbital or other barbiturates. 

Noninterfering aprobarbital, barbituric acid, ethinamate, ethosuximide, gentamicin, lidocaine, mebutemate, meprobamate, methadone, methyprylon, nirvanol, phenobarbital, procainamide, propox5q>hene, thioamyl, thioridazine, trifluoperazine, triflupromazine, ty-bamate, vinbarbital... 

Good relationships between the retention in MLC and some biological activities of local anesthetics (bupivacaine, lidocaine, mepiva-caine, prilocaine, procaine and tetracaine), such as anesthetic potency, concentration of compound that produces an effect similar to a reference concentration of cocaine, duration of the action, toxicity and time taken to eliminate half the drug present in the body, have also b n reported [24]. Some anesthetic actions of barbiturates also correlated well with the retention minimum effective hypnotic dose in rabbits, molar drug concentration necessary to reduce cell division, and molar drug concentration required to reduce 50% the inhibition of oxygen respiration on the brain of a rat in vitro [25],... 

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