Dr McGovern

Currently on Prezista/Norvir(800/100mg once daily)+Kivexa. Surgery is being planned to repair an ear perforation and wish to ensure that there are no significant negative drug-drug interactions. The following meds are to be used : Prulifloxacin(200mg bid) for two weeks to clear Chronic Mastoiditis, and Pseudoephedrine/loratidine and Cosinut also for two weeks for bilateral ethmoid and maxillary sinusitis. Further, Xylocaine will be used as a local anasthetic for the surgery. Are these medicines safe to take with the said regime ?.

In this respect, I wish to point out that the pamphlet for Prulifloxacin mentions that caution is needed for sufferers of panic attacks,which is the case here. Further, I have read in the CCo inPractice database that the interaction with Darunavir with Xylocaine has not been studied but could conceivably lead to serious and/or life-threatening reactions including cardiac arrhythmias and other toxicities. Would you suggest an alternative anesthetic or rather adjust the dose of Xylocaine and/or Darunavir ? If the latter option, what dose do you think would be appropriate?. Or else, would it perhaps be preferable not to take Darunavir/ritonavir for the 24h or 48h preceding and/or after the surgery ?

Thank you.

Axel

Dear Axel,

I do not think that you should have any problem. As you point out, the only potential interaction that should be watched is the xylocaine and darunavir. The darunavir may lead to an increased level of xylocaine. This could be overcome by using the smallest effective dose (which should be quite small in this type of surgery). I would not stop the medications. The real risk comes when lidocaine is given intravenously.

Best, Joe