Drugs to Avoid
About HomeMalignant Hyperpyrexia click to expand contents
This is not an exhaustive list. If you think something is wrong, please let me know
- Unsafe
-
- Volatile Agents
- Desflurane
Enflurane
Ether
Halothane
Isoflurane
Methoxyflurane
Sevoflurane - Muscle Relaxants
- Suxamethonium
- Local Anaesthesia
- Tetracaine - one case reported
- Safe
-
- Induction Agents, etc.
- Diazepam
Etomidate
Ketamine
Methohexitone
Midazolam
Propofol
Thiopentone - Inhalational
- Nitrous Oxide
- Local Anaesthesia
- Amethocaine
Bupivicaine
Lidocaine
Levobupivacaine
Procaine
Prilocaine
Ropivacaine
Proxymetacaine - Opiates
- Alfentanil
Codeine
Diamorphine
Fentanyl (Sublimaze)
Methadone
Morphine
Naloxone
Oxycodone
Pethidine
Phenoperidine
Remifentanil
Sufentanil - Muscle Relaxants
- Atracurium
Cisatracurium
Gallamine
Mivacurium
Pancuronium
Pipecuronium
Rocuronium
Tubocurarine
Vecuronium - Benzodiazepines
- Chlordiazepoxide
Clonazopam
Diazepam
Flurazepam
Lorazepam
Midazolam
Oxazepam
Temazepam
Triazolam - SSRIs
- Paxil (paroxetine)
Long-QT click to expand contents
This list is lifted from World J Cardiolv.5(4); 2013 Apr 26. I have marked in red the drugs we may use. If you think drugs should be added or marked red, please let me know.
- Unsafe
-
- Anaesthesia
- Sevoflurane
- Antibiotics
- Moxifloxacin, Clarithromycin, Ciprofloxacin, Gemifloxacin, Ofloxacin, Telithromycin, Levofloxacin, Roxithromycin, Trimethoprim, Gatifloxacin, Sparfloxacin, Azithromycin, Erythromycin
- Antianginal
- Ranolazine, Bepridil
- Antiarrythmic
- Sotalol, Quinidine, Amiodarone, Ibutilide, Disopyramide, Procainamide, Flecainide, Dofetilide, Dronedarone
- Anti-cancer
- Tamoxifen, Lapatinib, Nilotinib, Arsenic trioxide, Eribulin, Sunitinib, Vandetanib
- Anticonvulsant
- Fosphenytoin, Felbamate
- Anti-depressant
- Mirtazapine, Citalopram, Venlafaxine, Paroxetine, Fluoxetine, Sertraline, Trazodone, Escitalopram, Clomipramine, Amitriptyline, Imipramine, Nortriptyline, Desipramine, Doxepin, Trimipramine, Protriptyline
- Antifungal
- Voriconazole, Fluconazole, Ketoconazole, Itraconazole
- Antihistamine
- Astemizole, Terfenadine, Diphenhydramine
- Antihypertensive
- Nicardipine, Isradipine, Moexipril/HCTZ
- Antiinfective
- Pentamidine
- Antilipemic
- Probucol
- Anti-malarial
- Artenimol + piperaquine, Chloroquine, Halofantrine
- Antimanic
- Lithium
- Antiemetic
- Granisetron, Dolasetron, Droperidol, Ondansetron, Palonosetron is ok, Cyclizine is ok
- Antipsychotic
- Clozapine, Ziprasidone, Thioridazine, Risperidone, Mesoridazine, Quetiapine, Haloperidol, Pimozide, Amisulpride, Sertindole, Sertindole, Iloperidone, Paliperidone, Chlorpromazine
- Antiviral
- Foscarnet, Ritonavir, Atazanavir
- Appetite suppressant
- Phentermine, Fenfluramine, Sibutramine
- Bladder Antispasmodic
- Tolterodine
- α1-blocker
- Alfuzosin, Bronchodilator/decongestant, Albuterol, Salmeterol, Metaproterenol, Terbutaline, Metaproterenol, Levalbuterol, Ephedrine, Phenylpropanolamine, Pseudoephedrine
- Cholinesterase inhibitor
- Galantamine
- CNS stimulant
- Amphetamine, Methylphenidate, Dexmethylphenidate, Lisdexamfetamine
- Diuretic
- Indapamide
- Dopaminergic, antiviral/infective
- Amantadine
- Endocrine
- Ocreotide
- GI stimulant
- Cisapride
- H2-receptor antagonist
- Famotidine
- Imaging contrast agent
- Perflutren lipid microspheres
- Immunosuppressant
- Tacrolimus, Fingolimod
- Inotrope/vasconstrictor
- Dopamine, Isoproterenol, Dobutamine, Adrenaline, Noradrenaline, Phenylephrine
- Local anesthetic
- Cocaine
- Muscarinic anatagonist
- Solifenacin
- Muscle relaxant
- Tizanidine
- NA reuptake inhibitor
- Atomoxetine
- Opiate agonist
- Methadone, Levomethadyl
- Oxytocic
- Oxytocin
- PDE inhibitor/vasodilator
- Vardenafil
- Sedative
- Chloral hydrate
- Uterine relaxant
- Ritodrine
Myasthenia Gravis click to expand contents
This list is lifted from various sources including Myaware (UK Myasthenia group), FRCA.co.uk and individual studies. The difficulty I had finding a definitive list impressed that it may not be complete!
Incidentally, Myaware seems a very useful site.
I have marked in red the drugs we may use. If you think drugs should be added or marked red, please let me know.
- Unsafe
-
- Antibiotics
-
Macrolides
Azithromycin, Erythromycin, Telithromycin,QuinolonesAcrosoxacin, Cinoxacin, Ciprofloxacin, Naladixic Acid, Norfloxacin, OfloxacinAminoglycosidesAmikacin, Gentamicin, Kanamicin, Netilmicin, Streptomycin, TobramycinTetracyclinesDoxycycline, Lymecycline, Minocycline, Oxytetracycline, TetracyclineChloroquinesChloroquine, Hydroxychloroquine
- Antidysrhythmics
-
β-blockers
Acebutolol, Atenolol, Betaxolol, Bisoprolol, Carvedilol, Celiprolol, Esmolol, Labetalol, Metoprolol, Nadolol, Oxprenolol, Pindolol, Propranolol, Sotalol, TimololCalcium Channel BlockersVerapamil (in dose > 0.1 mg/kg, rate >1 mg/min)Class I antiarrythmicQuinidine, Procainamide, Lidocaine (IV. OK for LA)
- Antiemetics
-
Phenothiazines
Prochlorperazine
- Ganglion Blockers
-
Trimetaphan
- Muscle relaxants
-
Atracurium, cis-Atracurium, Mivacurium (has been used), Pancuronium, Rocuronium, Tubocurarine, Vecuronium
- Miscellaneous
-
ACTH, Chlorpromazine, Clozapine, Corticosteroids (paradoxically), Diphenylhydantoin, Flupenthixol, Isocarboxacid, Levothyroxine, Lithium, Loxapine, Methotrimeprazine, Oxypertine, Pericyazine, Perphenazine, Phenelzine, Pimozide, Promazine, Phenytoin, Risperidone, Sulpiride, Thioridazine, Tranylcypromide, Trifluoroperazine, Zuclopenthixol
About
I don't know about you, but whenever I come across with someone with MH, long-QT or Myasthenia Gravis, I always think I know what drugs to avoid, but then some self-doubt creeps in and then I look it up. I then find it sometimes is not that simple...
Hopefully this will help