Drugs to Avoid

Malignant Hyperpyrexia

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

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
    Note: Palonosetron and Cyclizine are ok
  • Antipsychotic
  • Clozapine, Ziprasidone, Thioridazine, Risperidone, Mesoridazine, Quetiapine, Haloperidol, Pimozide, Amisulpride, Sertindole, Sertindole, Iloperidone, Paliperidone, Chlorpromazine
  • Aniviral
  • 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 anaesthetic
  • Cocaine
  • Muscarinic antagonist
  • Solifenacin
  • Muscle relaxant
  • Tizanidine
  • NA reuptake inhibitor
  • Atomoxetine
  • Opiate agonist
  • Methadone, Levomethadyl
  • Oxytocic
  • Oxytocin
  • PDE inhibitor/vasodilator
  • Vardenafil
  • Sedative
  • Chloral hydrate
  • Uterine relaxant
  • Ritodrine
  • Vasoconstrictor
  • Midodrine

Myasthenia Gravis

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,
    Quinolones
    Acrosoxacin, Cinoxacin, Ciprofloxacin, Naladixic Acid, Norfloxacin, Ofloxacin
    Aminoglycosides
    Amikacin, Gentamicin, Kanamicin, Netilmicin, Streptomycin, Tobramycin
    Tetracyclines
    Doxycycline, Lymecycline, Minocycline, Oxytetracycline, Tetracycline
    Chloroquines
    Chloroquine, Hydroxychloroquine
  • Antidysrhythmics
  • β-blockers
    Acebutolol, Atenolol, Betaxolol, Bisoprolol, Carvedilol, Celiprolol, Esmolol, Labetalol, Metoprolol, Nadolol, Oxprenolol, Pindolol, Propranolol, Sotalol, Timolol
    Calcium Channel Blockers
    Verapamil (in dose > 0.1 mg/kg, rate >1 mg/min)
    Class I antiarrythmic
    Quinidine, 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