Issues for surgery
For treatment of hypertension – loss of blood pressure (BP) control if omitted.
For treatment of angina – exacerbation of angina if omitted.
Risk of hypotension when continued.
Advice in the perioperative period
Elective and emergency surgery
Continue.
EXCEPT:
- Combination products containing felodipine and ramipril, follow advice as for ramipril - see Ramipril monograph
Consideration should be given to prescribing the components of combination products as separate medicines perioperatively.
Post-operative advice
Restart post-operatively when next dose is due.
Monitor BP.
Interactions with common anaesthetic agents
Inhalational Anaesthetics
See also Hypotension below.
Felodipine may reduce the minimum alveolar concentration (MAC) of inhalational anaesthetics by up to 20%.
Hypotension
Felodipine can increase the risk of hypotension when used concomitantly with remifentanil or inhalational / intravenous anaesthetics.
Neuromuscular blocking drugs (NMBDs)
Felodipine may prolong neuromuscular blockade when used concomitantly with NMBDs. The clinical significance is unknown, but bear the potential interaction in mind in case of unexpected response to treatment.
Interactions with other common medicines used in the perioperative period
Hypotension
Felodipine can increase the risk of hypotension when used concomitantly with droperidol or prochlorperazine.
Macrolide antibiotics
Macrolide antibiotics (e.g. clarithromycin, erythromycin), which are inhibitors of CYP3A4, may increase the effects of felodipine leading to hypotension. Monitor the patient and consider reducing the dose of the calcium-channel blocker if necessary.
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring. Consult current product literature.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12th April 2019]
British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12th April 2019]
The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. European Heart Journal. 2014; 35:2383-2431
Scarth E, Smith S. Drugs in Anaesthesia and Intensive Care, 5th Edition. Oxford University Press; 2016
Summary of Product Characteristics – Cardioplen XL® (felodipine) 10 mg Prolonged Release Tablets. Chiesi Limited. Accessed via www.medicines.org.uk 09/10/2019 [date of revision of the text May 2017]