PharmPK Discussion - Local anaesthetic/opioid mixture stability

PharmPK Discussion List Archive Index page

On 6 Aug 1998 at 10:55:55, andrew.ferguson.at.virgin.net (andrew.ferguson.aaa.virgin.net) sent the message


 Does anyone have any information on the stability of local
anaesthetic/opioid mixtures for epidural or intrathecal use?

e.g. bupivacaine (hyperbaric) + alfentanil
     Bupivacaine + diamorphine
     Bupivacaine + alfentanil + diamorphine

any thoughts much appreciated

Dr. A. Ferguson

Back to the Top

On 6 Aug 1998 at 15:14:53, Meyer Katzper (KATZPER.-a-.cder.fda.gov) sent the message


Caution is advisable as some data we have analyzed indicates that opioid
mixtures may have synergistic effects.
M. Katzper

Back to the Top

On 7 Aug 1998 at 11:25:23, Richard Molitor (rmolitor.-at-.u.washington.edu) sent the message


Which is why the combination has incresed in popularity over the years.
According to my local guru-MD the combination of
opiate/anesthetic or opiate/anesthetic/clonidine epidurally (or
intrathecally if desired volume can be achieved) provides a very powerful
tool in patients who have failed other regimens.  I suspect there'll be an
increasing amount of literature on this topic in the next few years (My
first pharmacy-related papers on this topic were presented in 1987-1988).

Richard Molitor, R.Ph.
http://www.angelfire.com/wa/pharmacist/

Back to the Top

On 7 Aug 1998 at 11:25:02, Richard Molitor (rmolitor.-at-.u.washington.edu) sent the message


Loyd Allen & Mary Lou Stiles published a number of reports on
morphine/bupivacaine (and I believe fentanyl/bupivacaine) at the behest of
Pharmacia Deltec in the late 80's and early 90's.  That was due to the
increasing popularity of epidural infusions of those agents via permanent
epidural catheters such as the DuPen (Bard/Davol).

Morphine and clonidine have also been shown to be compatible in a recent
report by Schobelock et al (addressing IT administration).

Additional studies are most certainly on file with the Deltec Company
(makers of the CADD-Prizm pump) or even Roxane.  Diamorphine and
alfentanil aren't commonly used in the US (due to cost and availability)
but morphine, fentanyl, and sufentanil have all been combined successfully
with bupivacaine (or bupivacaine w/epi) to provide successful pain
management in terminal patients (back in the mid-80s I was one of the
first home infusion pharmacists to prepare these admixtures...)

Hope this helps,

Richard Molitor, R.Ph.
http://www.angelfire.com/wa/pharmacist/

Back to the Top

On 11 Aug 1998 at 15:19:37, "Randy Trinkle" (rtrinkle.-at-.skylite.datanet.ab.ca) sent the message


This is why the combination is used.  Combining an anesthetic and
opiate provides excellent pain control and reduces the risk of
side effects from monotherapy.

***************************************
Randy Trinkle, BScPharm, BA
mailto:rtrinkle.aaa.datanet.ab.ca
Health Science links:
http://www.datanet.ab.ca/users/rtrinkle
***************************************

Back to the Top

Want to post a follow-up message on this topic? If this link does not work with your browser send a follow-up message to PharmPK@boomer.org with "Local anaesthetic/opioid mixture stability" as the subject

PharmPK Discussion List Archive Index page