Chemical formula: C₁₃H₁₉ClN₂O₂ Molecular mass: 270.755 g/mol PubChem compound: 8612
Chloroprocaine interacts in the following cases:
The para-aminobenzoic acid metabolite of chloroprocaine inhibits the action of sulfonamides. Therefore, chloroprocaine should not be used in any condition in which a sulfonamide drug is being employed.
Concurrent administration of vasopressor drugs (e.g. for the treatment of hypotension related to obstetric blocks) and ergot-type oxytocic drugs may cause severe, persistent hypertension or cerebrovascular accidents.
Patients treated with class III antiarrhythmic agents (e.g. amiodarone) should be subjected to careful observation and ECG monitoring, since cardiac effects may be added.
Concurrent use of cholinesterase inhibitors such as antimyasthenics, cyclophosphamide, echotiophate may inhibit the metabolism of chloroprocaine leading to increased risk of toxicity.
The combination of various local anaesthetics induces additional effects which affect the cardiovascular system and the CNS.
Some patients require special attention in order to reduce the risk of serious undesirable effects, even when locoregional anaesthesia constitutes the optimum choice for the surgical intervention:
There is no suspicion that neurological disorders, such as multiple sclerosis, hemiplegia, paraplegia or neuromuscular disorders may be negatively influenced by spinal anaesthesia. Nevertheless, it should be used with care. Careful evaluation of the risk-benefit ratio is recommended prior to treatment.
In patients with acute porphyria, chloroprocaine should only be administered when there is a compelling indication for its use, as it may potentially precipitate porphyria. Appropriate precautions should be taken in all patients with porphyria.
Animal studies are insufficient with respect to effects on pregnancy and foetal development. Therefore, chloroprocaine is not recommended during pregnancy and in women of childbearing potential not using contraception. The use of chloroprocaine in pregnancy should only be considered if the expected benefit to the mother outweighs any potential risk to the foetus. This does not preclude the use of chloroprocaine at term for obstetrical anaesthesia.
It is not known whether chloroprocaine/metabolites are excreted in human milk.
No fertility studies the have been performed.
Chloroprocaine has major influence on the ability to drive and use machines. The doctor is responsible for deciding in each individual case if the patient can drive or use machines.
The possible undesirable effects due to the use of chloroprocaine are generally similar to the undesirable effects of other local anaesthetics for spinal anaesthesia from the ester group. The undesirable effects induced by the medicinal product are difficult to distinguish from the physiological effects of the nerve block (e.g. reduction in arterial pressure, bradycardia, temporary urine retention), from direct effects (e.g. spinal hematoma) or the indirect effects (e.g. meningitis) of the injection or from the effects due to the loss of cerebrospinal liquid (e.g. post-spinal headache).
The frequency of undesirable effects listed below is defined using the following convention: Very common (≥1/10), Common (≥1/100 to <1/10), Uncommon (≥1/1,000 to <1/100), Rare (≥1/10,000 to <1/1,000), Very rare (<1/10,000), Not known (cannot be estimated from the available data).
Rare: allergic reactions as a result of sensitivity to the local anaesthetic, characterized by signs such as urticaria, pruritus, erythema, angioneurotic edema with possible airway obstruction (including laryngeal edema), tachycardia, sneezing, nausea, vomiting, dizziness, syncope, excessive sweating, elevated temperature, and possibly, anaphylactoid type symptomatology (including severe hypotension).
Common: anxiety, restlessness, paresthesia, dizziness.
Uncommon: signs and symptoms of CNS toxicity (backache, headache, tremors possibly proceeding to convulsions, convulsions, circumoral paresthesia, feeling of numbness affecting the tongue, hearing problems, visual problems, blurred vision, shaking, tinnitus, speech problems, loss of consciousness).
Rare: neuropathy, drowsiness merging into unconsciousness and respiratory arrest, spinal block of varying magnitude (including total spinal block), hypotension secondary to spinal block, loss of bladder and bowel control, and loss of perineal sensation and sexual function, arachnoiditis, persistent motor, sensory and/or autonomic (sphincter control) deficit of some lower spinal segments with slow recovery (several months), cauda equina syndrome and permanent neurological injury.
Rare: diplopia
Rare: arrhythmia, depression of the myocardium, cardiac arrest (the risk is increased by high doses or unintended intravascular injection).
Very common: hypotension.
Uncommon: bradycardia, hypertension, hypotension raised by high doses.
Rare: respiratory depression
Very common: nausea
Common: vomiting.
The possible undesirable effects due to the use of chloroprocaine are generally similar to the undesirable effects of other local anaesthetics for regional anaesthesia from the ester group. These undesirables effects are generally dose related and may result from rapid absorption from the injection site, diminished tolerance, or from unintentional intravascular injection of the local anaesthetic solution. In addition to systemic dose-related toxicity, unintentional subarachnoid injection of drug during the intended performance of nerve blocks near the vertebral column (especially in the head and neck region) may result in underventilation or apnea (“Total Spinal”). The undesirable effects induced by the medicinal product are difficult to distinguish from the physiological effects of the nerve block (e.g. reduction in arterial pressure, bradycardia), from direct effects (e.g. nerve injury) or the indirect effects (e.g. nerve inflammation) of the needle puncture.
The frequency of undesirable effects listed below is defined using the following convention: Very common (≥1/10), Common (≥1/100 to <1/10), Uncommon (≥1/1,000 to <1/100), Rare (≥1/10,000 to <1/1,000), Very rare (<1/10,000), Not known (cannot be estimated from the available data).
Rare: allergic reactions as a result of sensitivity to the local anaesthetic, characterized by signs such as urticaria, pruritus, erythema, angioneurotic edema with possible airway obstruction (including laryngeal edema), tachycardia, sneezing, nausea, vomiting, dizziness, syncope, excessive sweating, elevated temperature, and possibly, anaphylactoid type symptomatology (including severe hypotension).
Common: anesthetic complication.
Common: anxiety, restlessness, paresthesia, dizziness.
Uncommon: signs and symptoms of CNS toxicity (tremors possibly proceeding to convulsions, convulsions, circumoral paresthesia, feeling of numbness affecting the tongue, hearing problems, visual problems, blurred vision, shaking, tinnitus, speech problems, loss of consciousness).
Rare: neuropathy, drowsiness merging into unconsciousness and respiratory arrest, loss of bladder and bowel control, and loss of perineal sensation and sexual function and permanent neurological injury.
Rare: diplopia.
Uncommon: bradycardia.
Rare: arrhythmia, depression of the myocardium, cardiac arrest (the risk is increased by high doses or unintended intravascular injection).
Very common: hypotension.
Uncommon: hypertension, hypotension raised by high doses.
Rare: dyspnoea.
Very common: nausea.
Common: vomiting.
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