FENTANYL Drug Interactions
Also known as: FENTANYL
FENTANYL (brand name: FENTANYL) is a Opioid Analgesics. 1 INDICATIONS AND USAGE Fentanyl transdermal system is indicated for the management of severe and persistent pain in opioid-tolerant patients, that requires an opioid analgesic and that cannot be adequately treated with alternative options, including immediate-release opioids. Patients considered…FENTANYL has 17 documented drug interactions in our database, including 3 contraindicated, 14 major, 0 moderate, and 0 minor interactions.
3
Contraindicated
14
Major
0
Moderate
0
Minor
Concomitant use significantly increases the risk of severe respiratory depression, profound sedation, coma, and death. Patients may experience decreased respiratory rate, shallow breathing, hypoxemia, unresponsiveness, and circulatory collapse.
Mechanism
Fentanyl, an opioid agonist, and oxazepam, a benzodiazepine, both exert central nervous system (CNS) depressant effects. The co-administration leads to additive pharmacodynamic depression of the CNS, particularly affecting the respiratory drive and level of consciousness.
Clinical Management
Avoid co-prescription of fentanyl and oxazepam due to the high risk of severe adverse outcomes, including death. If concurrent use is unavoidable, use the lowest effective doses for the shortest possible duration, monitor patients closely for respiratory depression and sedation, and ensure naloxone is readily available. Consider alternative treatments that do not carry this interaction risk.
The combination can lead to profound sedation, respiratory depression (decreased respiratory rate and depth), coma, and death. Patients may experience extreme drowsiness, confusion, dizziness, and difficulty breathing. This interaction significantly impairs psychomotor function and decision-making.
Mechanism
Fentanyl, an opioid agonist, binds to mu-opioid receptors, leading to central nervous system (CNS) depression, including respiratory depression. Temazepam, a benzodiazepine, enhances the effect of gamma-aminobutyric acid (GABA) at GABA-A receptors, also resulting in CNS depression. The synergistic CNS depressant effects of both drugs significantly increase the risk of severe adverse outcomes.
Clinical Management
Concomitant use of fentanyl and temazepam is contraindicated due to the high risk of respiratory depression and death. If co-administration is unavoidable, extreme caution, reduced doses of both medications, and close monitoring for respiratory depression and sedation are imperative. Patients and caregivers must be educated on the risks and symptoms, and naloxone should be readily available.
Concomitant use can lead to severe adverse effects including profound sedation, respiratory depression, coma, and death. Patients may exhibit decreased level of consciousness, hypoventilation, hypoxia, and hypotension.
Mechanism
Fentanyl, an opioid agonist, and chlordiazepoxide, a benzodiazepine, both act as central nervous system (CNS) depressants. Their co-administration results in an additive and synergistic depressant effect on the CNS, particularly on brainstem respiratory centers, leading to profound respiratory depression.
Clinical Management
Concomitant use of fentanyl and chlordiazepoxide is generally contraindicated due to the high risk of serious adverse outcomes. If co-administration is absolutely necessary and no alternatives exist, use the lowest effective doses for the shortest duration possible, and monitor patients closely for signs of respiratory depression and sedation. Have naloxone readily available.
Patients may experience profound sedation, respiratory depression (ranging from hypoventilation to apnea), hypotension, and psychomotor impairment. This can lead to an increased risk of falls, accidental injury, and life-threatening respiratory compromise.
Mechanism
Fentanyl, an opioid analgesic, acts primarily on mu-opioid receptors in the central nervous system (CNS) to produce analgesia and respiratory depression. Cyclobenzaprine, a skeletal muscle relaxant, also exerts its effects through CNS depression, likely via its structural similarity to tricyclic antidepressants and its actions on brainstem centers. The co-administration of these agents results in additive CNS depressant effects.
Clinical Management
Avoid concomitant use of fentanyl and cyclobenzaprine if possible. If co-administration is unavoidable, reduce the dosage of one or both drugs, monitor patients closely for signs of respiratory depression and sedation, and educate them on the risks. Naloxone should be readily available for opioid-induced respiratory depression.
This additive CNS depression can manifest as profound sedation, dizziness, confusion, and psychomotor impairment. Most critically, it significantly increases the risk of severe respiratory depression, which can be life-threatening. Patients may also experience hypotension and impaired coordination.
Mechanism
Fentanyl, an opioid analgesic, primarily acts on mu-opioid receptors in the central nervous system (CNS) to produce analgesia, sedation, and respiratory depression. Methocarbamol, a centrally acting muscle relaxant, also exerts its effects through general CNS depression, though its precise mechanism is not fully understood. The co-administration of these two agents results in an additive depressant effect on the CNS.
Clinical Management
Concomitant use of fentanyl and methocarbamol should generally be avoided due to the high risk of severe CNS and respiratory depression. If co-administration is deemed absolutely necessary, initiate both medications at the lowest effective doses and titrate cautiously. Closely monitor patients for signs of respiratory depression, sedation, and altered mental status, especially during initiation or dose adjustments. Consider alternative pain management or muscle relaxant strategies if possible.
Patients may experience profound sedation, respiratory depression, hypotension, psychomotor impairment, and coma. This combination significantly increases the risk of accidental overdose, life-threatening respiratory arrest, and death. Impaired motor coordination can also increase the risk of falls and accidents.
Mechanism
Both fentanyl, an opioid agonist, and carisoprodol, a centrally acting muscle relaxant, exert depressant effects on the central nervous system (CNS). Carisoprodol is metabolized to meprobamate, which also possesses significant CNS depressant and anxiolytic properties. The co-administration leads to an additive pharmacological effect, enhancing CNS depression.
Clinical Management
Avoid concomitant use of fentanyl and carisoprodol whenever possible. If co-administration is unavoidable, reduce the dose of one or both drugs, initiate at the lowest effective dose, and monitor patients closely for signs of respiratory depression, sedation, and hypotension. Educate patients on the risks and advise against operating heavy machinery or driving.
Patients may experience profound sedation, respiratory depression, hypotension, and psychomotor impairment. This can manifest as unresponsiveness, shallow breathing, decreased oxygen saturation, and an increased risk of falls or accidents. The combination significantly increases the risk of life-threatening respiratory depression.
Mechanism
Fentanyl, an opioid agonist, primarily acts on mu-opioid receptors in the central nervous system (CNS) to produce analgesia and CNS depression. Baclofen, a GABA-B receptor agonist, also exerts its muscle relaxant effects and CNS depression through actions in the brain and spinal cord. The co-administration of these two agents leads to an additive depressant effect on the CNS.
Clinical Management
Avoid concomitant use of fentanyl and baclofen if possible. If co-administration is unavoidable, initiate both medications at the lowest effective doses and titrate slowly while closely monitoring for signs of CNS and respiratory depression. Educate patients and caregivers on the symptoms of respiratory depression and excessive sedation, and consider prescribing naloxone if appropriate for opioid overdose reversal.
Patients may experience severe respiratory depression, characterized by decreased respiratory rate and depth, potentially leading to hypoxemia and hypercapnia. Other clinical effects include profound sedation, excessive somnolence, dizziness, impaired psychomotor function, and hypotension. This combination significantly increases the risk of falls, accidental injury, and life-threatening respiratory compromise.
Mechanism
Both fentanyl, an opioid agonist, and tizanidine, an alpha-2 adrenergic agonist muscle relaxant, exert significant central nervous system (CNS) depressant effects. Their co-administration leads to an additive pharmacological effect, increasing the overall CNS depression. This synergistic action primarily affects neuronal excitability and neurotransmitter release, leading to profound sedation and respiratory depression.
Clinical Management
Concomitant use should generally be avoided due to the high risk of severe adverse effects. If co-administration is unavoidable, initiate both medications at the lowest effective doses and titrate cautiously while closely monitoring for signs of respiratory depression and sedation. Educate patients and caregivers on the symptoms of CNS depression and advise against operating heavy machinery or driving. Consider alternative non-opioid analgesics or non-pharmacological muscle relaxants if possible.
Patients may experience increased sedation, dizziness, confusion, and impaired coordination. The most serious clinical effect is respiratory depression, which can be life-threatening. Other effects include hypotension, syncope, and coma.
Mechanism
Both fentanyl, an opioid analgesic, and metaxalone, a centrally acting muscle relaxant, exert central nervous system (CNS) depressant effects. When co-administered, their individual CNS depressant actions are additive, leading to an increased risk of profound sedation, respiratory depression, and psychomotor impairment. This interaction primarily involves their respective effects on GABAergic and opioid receptors in the brain.
Clinical Management
Concomitant use should be avoided if possible. If co-administration is necessary, initiate both drugs at the lowest effective doses and titrate carefully, monitoring closely for signs of respiratory depression and excessive sedation. Educate patients about the risks and advise against driving or operating heavy machinery. Consider alternative non-opioid analgesics or non-pharmacological treatments.
Concomitant use can result in profound sedation, respiratory depression, hypotension, and psychomotor impairment. Patients may experience dizziness, confusion, and difficulty with coordination, increasing the risk of falls and accidents. In severe cases, this interaction can lead to respiratory arrest and death.
Mechanism
Fentanyl, an opioid analgesic, primarily acts on mu-opioid receptors in the central nervous system (CNS) to produce analgesia and respiratory depression. Chlorzoxazone, a centrally acting skeletal muscle relaxant, also exerts its effects through CNS depression, likely by inhibiting polysynaptic reflexes at the spinal cord and subcortical levels. The co-administration of these agents leads to an additive depressant effect on the CNS.
Clinical Management
Avoid concomitant use of fentanyl and chlorzoxazone if possible. If co-administration is necessary, initiate both medications at lower doses and titrate carefully while closely monitoring for signs of CNS and respiratory depression. Educate patients about the risks and advise against operating heavy machinery or driving. Consider alternative non-opioid analgesics or non-pharmacological muscle relaxants.
Patients may experience severe respiratory depression, including hypoventilation and apnea, profound sedation, somnolence, and decreased level of consciousness. Other potential effects include dizziness, impaired psychomotor function, and increased risk of falls. In severe cases, this can lead to coma and death.
Mechanism
Both fentanyl, an opioid analgesic, and orphenadrine citrate, a skeletal muscle relaxant with anticholinergic and antihistaminic properties, exert central nervous system (CNS) depressant effects. The co-administration leads to an additive pharmacological effect on GABAergic and other inhibitory neurotransmitter systems, significantly enhancing CNS depression. This synergistic action increases the risk of profound respiratory depression and sedation.
Clinical Management
Avoid concomitant use of fentanyl and orphenadrine citrate if possible. If co-administration is unavoidable, reduce the starting dose of one or both medications, particularly the opioid, and monitor patients closely for signs of respiratory depression and sedation. Educate patients on the risks and advise them to avoid activities requiring mental alertness, such as driving or operating heavy machinery.
This combination significantly increases the risk of severe respiratory depression, profound sedation, coma, and death. Patients may experience decreased level of consciousness, hypoventilation, hypoxia, and hypotension. These effects can be life-threatening if not promptly recognized and managed.
Mechanism
Fentanyl, an opioid agonist, primarily acts on mu-opioid receptors in the central nervous system (CNS) to produce analgesia and respiratory depression. Lorazepam, a benzodiazepine, enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) at GABA-A receptors. The co-administration of these CNS depressants results in synergistic depression of respiratory drive and CNS activity.
Clinical Management
Avoid concomitant use of fentanyl and lorazepam whenever possible. If co-administration is unavoidable, use the lowest effective doses and shortest possible duration, and closely monitor patients for signs of respiratory depression and sedation. Ensure naloxone is readily available, and educate patients and caregivers about the risks and symptoms requiring immediate medical attention.
Patients may experience severe respiratory depression, leading to hypoxemia, apnea, and potentially respiratory arrest. Profound sedation, somnolence, dizziness, and impaired psychomotor function are common. In severe cases, this interaction can result in coma and death.
Mechanism
Fentanyl, an opioid agonist, primarily acts on mu-opioid receptors in the central nervous system (CNS) to produce analgesia and respiratory depression. Clonazepam, a benzodiazepine, enhances the inhibitory effects of gamma-aminobutyric acid (GABA) at GABA-A receptors. The synergistic CNS depressant effects of both drugs lead to profound respiratory depression, sedation, and hypotension.
Clinical Management
Avoid co-prescription if possible. If co-administration is unavoidable, prescribe the lowest effective doses and for the shortest duration possible. Closely monitor patients for signs of respiratory depression, sedation, and hypotension, especially during initiation or dose escalation. Educate patients and caregivers on the risks and symptoms to watch for, and provide naloxone if appropriate.
The combination can lead to profound sedation, respiratory depression (decreased respiratory rate and depth), hypotension, psychomotor impairment, coma, and death. Patients may exhibit somnolence, confusion, dizziness, and difficulty arousing. The onset of these effects can be rapid and severe.
Mechanism
Both fentanyl (an opioid) and diazepam (a benzodiazepine) are central nervous system (CNS) depressants. Fentanyl acts primarily as a mu-opioid receptor agonist, while diazepam enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) at GABA-A receptors. The concomitant use of these agents leads to an additive and synergistic CNS depressant effect, significantly increasing the risk of respiratory depression.
Clinical Management
Concomitant use should generally be avoided due to the high risk. If co-administration is absolutely necessary, use the lowest effective doses for the shortest possible duration, and monitor patients closely for signs of respiratory depression and sedation. Consider alternative treatments that do not interact with CNS depressants. Educate patients and caregivers about the risks and symptoms to watch for.
The concurrent use of fentanyl and alprazolam significantly increases the risk of severe respiratory depression, profound sedation, coma, and death. Patients may experience decreased respiratory rate and depth, hypoxemia, altered mental status, somnolence, and psychomotor impairment. These effects can be life-threatening and require immediate medical intervention.
Mechanism
Fentanyl, an opioid agonist, binds to mu-opioid receptors in the central nervous system (CNS), leading to dose-dependent CNS depression, including respiratory depression. Alprazolam, a benzodiazepine, enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) at GABA-A receptors, also causing CNS depression. The co-administration of these two CNS depressants results in an additive and synergistic depressant effect on the brainstem respiratory centers and overall CNS function.
Clinical Management
Avoid concomitant use of fentanyl and alprazolam whenever possible due to the high risk of severe adverse outcomes. If co-administration is unavoidable, prescribe the lowest effective doses for the shortest possible duration, monitor patients closely for signs of respiratory depression and sedation, and educate patients and caregivers about these risks. Have naloxone readily available for opioid overdose reversal.
The concurrent use significantly increases the risk of severe respiratory depression, profound sedation, hypotension, psychomotor impairment, coma, and death. Patients may experience decreased respiratory rate and depth, somnolence, confusion, and unresponsiveness.
Mechanism
Both fentanyl, an opioid agonist, and triazolam, a benzodiazepine, are central nervous system (CNS) depressants. Their co-administration leads to an additive depressant effect on the CNS, primarily by enhancing GABAergic neurotransmission (benzodiazepines) and inhibiting neuronal activity (opioids), particularly in brainstem respiratory centers.
Clinical Management
Avoid concomitant use whenever possible. If co-prescription is unavoidable, use the lowest effective doses and shortest possible duration. Closely monitor patients for signs of respiratory depression and sedation, especially during initiation or dose escalation of either drug. Educate patients and caregivers on the risks and symptoms to watch for.
The primary clinical effects of this interaction include profound sedation, respiratory depression (ranging from hypoventilation to apnea), hypotension, bradycardia, coma, and death. Patients may exhibit reduced level of consciousness, difficulty arousing, shallow breathing, cyanosis, and decreased oxygen saturation. These effects can be rapid in onset and life-threatening.
Mechanism
Fentanyl, an opioid agonist, primarily acts on mu-opioid receptors in the central nervous system (CNS), leading to dose-dependent CNS depression, including respiratory depression and sedation. Midazolam, a benzodiazepine, enhances the effect of gamma-aminobutyric acid (GABA) at GABA-A receptors, also resulting in CNS depression, anxiolysis, and sedation. The co-administration of these two classes of drugs produces additive and synergistic CNS and respiratory depressant effects.
Clinical Management
Avoid concomitant use of fentanyl and midazolam whenever possible due to the high risk of severe adverse effects. If co-administration is unavoidable, use the lowest effective doses for the shortest duration possible, and closely monitor patients for signs of respiratory depression and sedation. Have naloxone and flumazenil readily available, and educate patients and caregivers on the risks and symptoms of overdose.
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