Drug interactions
Codeine + Fentanyl intranasal
Severity: Major
Codeine and Fentanyl intranasal: 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
Using codeine with intranasal fentanyl combines two opioids, increasing the risk of profound sedation, respiratory depression, hypotension, coma and death. Fentanyl's potency makes this overlap particularly hazardous.
What this interaction means in plain words
Codeine and Fentanyl intranasal 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.
Why it happens
Additive mu-opioid receptor agonism causing CNS and respiratory depression.
What to do
Avoid concurrent opioids where possible; if needed, reduce doses of one or both and monitor respiratory rate, blood pressure and sedation.
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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
Frequently asked questions
Can I take Codeine with Fentanyl intranasal?
MediHelp rates the interaction as major. Codeine and Fentanyl intranasal 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. Using codeine with intranasal fentanyl combines two opioids, increasing the risk of profound sedation, respiratory depression, hypotension, coma and death. Fentanyl's potency makes this overlap particularly hazardous.
How serious is the interaction between Codeine and Fentanyl intranasal?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent opioids where possible; if needed, reduce doses of one or both and monitor respiratory rate, blood pressure and sedation.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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