Ropivacaine Fluvoxamine

Arlander E, Ekstrom G, Aim C, Carrillo JA, Bielenstein M, Bottiger Y, Bertilsson L, Gustafsson LL. Metabolism of ropivacaine in humans is mediated by CYP1A2 and to a minor extent by CYP3A4 an interaction study with fluvoxamine and ketoconazole as in vivo inhibitors. Chn Pharmacol Ther 1998 64(5) 484-91. 

Fluvoxamine inhibits the ciearance of ropivacaine therefore, proionged administration of ropivacaine shouid be avoided in patients taking fluvoxamine. 

Fluvoxamine decreased the mean total plasma clearance of ropivacaine by 68% from 354 to 112 mL/minute, and almost doubled the half-life of ropivacaine in a randomised, crossover study in 12 healthy subjects. Fluvoxamine was given at a dose of 25 mg twice daily for 2 days, and a single 40 mg intravenous dose of ropivacaine was given over 20 minutes one hour after the morning dose of fluvoxamine on the second day. Fluvoxamine is a potent inhibitor of the cytochrome P450 isoenzyme CYP1A2 and so reduces the metabolism of ropivacaine to its major metabolite 3-hydroxyropivacaine. In one study in healthy subjects the combination of fluvoxamine with erythromycin, an inhibitor of CYP3A4, which on its own has little effect on the pharmacokinetics of ropivacaine, was found to decrease the clearance of ropivacaine more than fluvoxamine alone. ... 

The UK manufacturer recommends that prolonged administration of ropivacaine should be avoided in patients concurrently treated with potent CYP1A2 inhibitors such as fluvoxamine. Be aware that CYP3A4 inhibitors such as erythromycin in combination with CYP1A2 inhibitors may further reduce ropivacaine clearance. ... 

Jokinen MJ, Ahonen J, Neuvonen PJ, OUdcola KT. The effect of eiydiromycin, fluvoxamine, and their combination on the pharmacokinetics of ropivacaine. AnesthAnalg (2000) 91,1207-12. 

Amperozide, amphetamine, methamphetamine, bambuterol, antidepressants (paroxetine, fluvoxamine, mianserin, and citalopram), anabolic steroids (glucuronides) promethazine, methadone, haloperidol, ibuprofen, naproxen, ketoprofen, propofol, ropivacaine Pb(ll), Mn(ll)... 

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