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Bupivacaine should be used with caution with other local anaesthetics or drugs that are structurally similar to local anaesthetics, i.e. class IB anti-arrhythmic drugs, as the systemic toxic effects are additive.
No specific interaction studies with local anaesthetics and class III anti-arrhythmic drugs (e.g. amiodarone) have been carried out, but caution is recommended (see Precautions).
Non-selective beta-blockers: Non-selective beta-blockers such as propranolol enhance the pressor effect of adrenaline, which may lead to pronounced hypertension and bradycardia. The combination might need dose adjustment.
Anaesthetics for inhalation: Adrenaline can cause severe cardiac arrhythmias when injected during general anaesthesia with halothane. The combination might need dose adjustment.
Tricyclic antidepressants: The pressor effect of adrenaline can, in combination with tricyclic antidepressants, cause a marked increase in blood pressure.
In short-term studies with high-dose intravenous adrenaline the effect has been shown to be increased 2- to 3-fold.
A combination of adrenaline-containing solutions and oxytocic drugs of the ergot type can cause a marked, persistent increase in blood pressure and may possibly cause cerebrovascular and cardiac accidents.
Phenothiazine derivatives and butyrophenone derivatives can decrease or inhibit the pressor effect of adrenaline.
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