Fentanyl

CNS depressant that increases risk of hypotension, respiratory depression, profound sedation, coma, and death when combined with fentanyl.

Mifepristone increases fentanyl exposure; concomitant use is contraindicated due to narrow therapeutic range.

Concomitant use increases risk of hypotension, respiratory depression, profound sedation, coma, and death. Reserve for patients where alternatives are inadequate.

Concomitant use increases risk of respiratory depression due to actions at different CNS receptor sites.

Concomitant use increases risk of respiratory depression due to additive CNS effects at different receptor sites. Monitor closely for respiratory depression and sedation.

May cause hypotension, bradycardia, and decreased cardiac output when combined with amiodarone.

Serotonergic drug that increases risk of serotonin syndrome when used concomitantly with amphetamine sulfate.

CYP3A4 inducer that decreases fentanyl plasma concentration, resulting in decreased efficacy and withdrawal syndrome. Discontinuation may cause serious respiratory depression.

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and discontinue if serotonin syndrome occurs.

Serotonergic drug that increases risk of serotonin syndrome when combined with amphetamines. Initiate with lower doses and monitor for serotonin syndrome signs.

Serotonergic drug increasing risk of serotonin syndrome with dextroamphetamine sulfate.

CYP3A4 inhibitor that increases fentanyl plasma concentration, resulting in increased or prolonged opioid effects, respiratory depression, and sedation.

CYP3A4 inhibitor that increases fentanyl plasma concentration, resulting in increased or prolonged opioid effects, respiratory depression, and sedation.

Fentanyl decreases MAC of isoflurane and may cause synergistic fall in blood pressure and respiratory rate when combined.

Severe hypotension has been reported during fentanyl anesthesia with concomitant use of beta blockers and calcium channel blockers, though not observed with isradipine specifically.

Itraconazole increases fentanyl concentrations, increasing risk of adverse reactions including respiratory depression. Not recommended during and 2 weeks after itraconazole treatment.

CYP3A4 inhibitor that increases fentanyl plasma concentration, resulting in increased or prolonged opioid effects, respiratory depression, and sedation.

Concomitant use may result in serotonin syndrome. Carefully observe patient during treatment initiation and dosage modification; discontinue metaxalone if serotonin syndrome occurs.

Concomitant use increases risk of respiratory depression and accentuates sedative effect. Monitor closely for respiratory depression and sedation.

Concomitant use increases risk of respiratory depression and sedation. Opioids interact at mu receptors while benzodiazepines act at GABA A sites, creating additive CNS depression.

Concomitant use increases risk of respiratory depression due to actions at different CNS receptor sites. Sedative effect of midazolam is accentuated.

Concomitant use increases risk of respiratory depression and accentuates sedative effect. Monitor closely for respiratory depression and sedation.

Concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms, particularly during initiation and dose increases.

Severe hypotension has been reported during fentanyl anesthesia with concomitant use of beta-blockers and calcium channel blockers. Increased circulating fluid volume may be required.

Severe hypotension has been reported during fentanyl anesthesia with concomitant use of beta-blockers and calcium channel blockers. An increased volume of circulating fluids might be required.

Concomitant use increases risk of serotonin syndrome.

CYP3A4 inducer that decreases fentanyl plasma concentration, resulting in decreased efficacy and withdrawal syndrome. Discontinuation may cause serious respiratory depression.

May increase anesthetic/sedative effects and cardiorespiratory depression. Concomitant use with propofol may result in serious bradycardia in pediatric patients.

May reduce induction dose requirements and increase anesthetic/sedative effects. In pediatric patients, concomitant administration may result in serious bradycardia.

CYP3A4 inducer that decreases fentanyl plasma concentration, resulting in decreased efficacy and withdrawal syndrome. Discontinuation may cause serious respiratory depression.

CYP3A4 inhibitor that increases fentanyl plasma concentration, resulting in increased or prolonged opioid effects, respiratory depression, and sedation.

Concomitant use of fentanyl with sertraline increases the risk of serotonin syndrome. Monitor patients for signs and symptoms.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during treatment initiation and dosage increases.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms during trazodone initiation.

Deferasirox may induce CYP3A4 resulting in decreased fentanyl concentration. Monitor for reduced effectiveness.

Intravenous fentanyl reduces MAC of desflurane by 46-64% at doses of 3-6 µg/kg. Adjust dose accordingly.

Concomitant use increases risk of serotonin syndrome. Monitor for symptoms and consider discontinuation if serotonin syndrome occurs.

Methylene blue inhibits CYP3A4/5 metabolism. Fentanyl has narrow therapeutic index; clinical relevance unknown but concurrent use requires caution.

Sensitive CYP3A substrate with narrow therapeutic index. Dose may need reduction when coadministered with palbociclib.

Caution advised due to potential for serotonin syndrome when coadministered with paroxetine.

Caution advised due to potential for serotonin syndrome when coadministered with paroxetine.