Drug interactions
Clozapine + Hydromorphone
Severity: Major
Clozapine and Hydromorphone: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Clozapine is strongly sedating and can cause orthostatic hypotension and, rarely, respiratory or circulatory collapse, which may be heightened by opioids like hydromorphone. The combination increases the risk of excessive sedation and respiratory depression.
What this interaction means in plain words
Clozapine and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Clozapine belongs to Central Nervous System; Hydromorphone belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression, with additive hypotensive effects.
What to do
Use reduced starting doses and titrate cautiously, monitoring sedation, blood pressure and respiratory rate. Avoid rapid dose escalation of either drug.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Frequently asked questions
Can I take Clozapine with Hydromorphone?
MediHelp rates the interaction as major. Clozapine and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Clozapine is strongly sedating and can cause orthostatic hypotension and, rarely, respiratory or circulatory collapse, which may be heightened by opioids like hydromorphone. The combination increases the risk of excessive sedation and respiratory depression.
How serious is the interaction between Clozapine and Hydromorphone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use reduced starting doses and titrate cautiously, monitoring sedation, blood pressure and respiratory rate. Avoid rapid dose escalation of either drug.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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