Formulary
Ropivacaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Ropivacaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Ropivacaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Ropivacaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Acute pain, Surgical anaesthesia for ropivacaine hydrochloride**
- **Child** (By regional administration): Adjust according to child's physical status and nature of procedure, seek expert advice.
Cautions
Acute porphyrias ; cardiovascular disease; complete heart block; debilitated patients (consider dose reduction); elderly (consider dose reduction); epilepsy; hypovolaemia; impaired cardiac conduction; impaired respiratory function; myasthenia gravis; shock
Contraindications
Avoid injection into infected tissues; avoid injection into inflamed tissues; intravenous regional anaesthesia (Bier's block); preparations containing preservatives should not be used for caudal, epidural, or spinal block Contra-indications, further information Injection site Manufacturer advises local anaesthetics should not be injected into inflamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.
Side effects
Common or very common Arrhythmias; back pain; chills; dizziness; headache; hypertension; hypotension; nausea; sensation abnormal; urinary retention; vomiting Uncommon Anxiety; dyspnoea; hypothermia; neurotoxicity; syncope Rare or very rare Cardiac arrest Frequency not known Dyskinesia Side-effects, further information Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.
Interactions
**Other interactions (5):**
- Ropivacaine hydrochloride should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics, e.g., certain antiarrhythmics,...
- Simultaneous use of Ropivacaine with general anaesthetics or opioids may potentiate each other's (adverse) effects.
- Specific interaction studies with ropivacaine hydrochloride and anti- arrhythmic drugs class III (e.g., amiodarone) have not been performed, but caution is advised (see section 4.4).
- Thus strong inhibitors of CYP1A2, such as fluvoxamine and enoxacin, given concomitantly during prolonged administration of Ropivacaine, can interact with ropivacaine hydrochloride.
- In vivo the plasma clearance of ropivacaine hydrochloride was reduced by 15% during coadministration of ketoconazole, a selective and potent inhibitor of CYP3A4.
Pregnancy
Not known to be harmful. Do not use for paracervical block in obstetrics.
Breast feeding
Not known to be harmful.
Hepatic impairment
Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises consider dose reduction for repeat doses in severe impairment.
Renal impairment
Caution in severe impairment. Increased risk of systemic toxicity in chronic renal failure.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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