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A Perfect Storm?

Fatal Forty DDI: omeprazole, nicardipine, diltiazem, bupivacaine, CYP3A4, CYP2C19, CYP2D6

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A Case Approach to Perioperative Drug-Drug Interactions

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Abstract

This case discusses the pharmacokinetic interactions between bupivacaine, nicardipine, omeprazole, and diltiazem. Bupivacaine is a cytochrome P450 3A4, 2C19, and 2D6 substrate and omeprazole, nicardipine, and diltiazem inhibit these, resulting in bupivacaine toxicity.

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Acknowledgment:

The editors wish to thank John E. Scharf MD for his contribution to the publication of this drug–drug interaction.

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Authors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Crozer Chester Medical Center, Upland, PA, USA

    J. Andrew Dziewit MD

  2. Section of Orthopedic Anesthesiology, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA

    Nabil M. Elkassabany MD

Authors
  1. J. Andrew Dziewit MD
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  2. Nabil M. Elkassabany MD
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Corresponding author

Correspondence to J. Andrew Dziewit MD .

Editor information

Editors and Affiliations

  1. Anesthesia Services Department, Philadelphia Veterans Affairs Med Center, Philadelphia, PA, USA

    Catherine Marcucci MD

  2. Department of Anesthesiology, Oregon Health and Science University, Portland, OR, USA

    Michael P. Hutchens MD

  3. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

    Erica D. Wittwer MD, PhD , Toby N. Weingarten MD , Juraj Sprung MD, PhD  & Wayne T. Nicholson MD, PharmD, MSc , ,  & 

  4. Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Kirk Lalwani MD

  5. Department of Anesthesiology, University of Pittsburgh School of Med Liliane S. Kaufmann Building, Pittsburgh, PA, USA

    David G. Metro MD

  6. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA

    Randal O. Dull MD, PhD

  7. Department of Anesthesiology, Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Christopher E. Swide MD

  8. Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA

    F. Jacob Seagull PhD

  9. Department of Anesthesiology and Perioperative Medicine, Portland, OR, USA

    Jeffrey R. Kirsch MD (Professor and Chair) (Professor and Chair)

  10. Department of Psychiatry, University of Maryland Medical System VA Maryland Health Care System, Baltimore, MD, USA

    Neil B. Sandson MD

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Dziewit, J.A., Elkassabany, N.M. (2015). A Perfect Storm?. In: Marcucci, C., et al. A Case Approach to Perioperative Drug-Drug Interactions. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7495-1_43

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  • DOI: https://doi.org/10.1007/978-1-4614-7495-1_43

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7494-4

  • Online ISBN: 978-1-4614-7495-1

  • eBook Packages: MedicineMedicine (R0)

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