Drug interactions
Doxepin + Meperidine
Severity: Major
Doxepin and Meperidine: 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
Meperidine has serotonergic activity, and doxepin, a tricyclic antidepressant, can add to this effect. The combination may precipitate serotonin syndrome with agitation, hyperthermia, clonus and autonomic instability. Meperidine can also lower seizure threshold.
What this interaction means in plain words
Doxepin and Meperidine 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.
Doxepin belongs to Dermatology; Meperidine belongs to Musculoskeletal.
Why it happens
Additive serotonergic effect from meperidine serotonin reuptake inhibition and doxepin reuptake inhibition.
What to do
Prefer a non-serotonergic opioid such as morphine; if combined, monitor for serotonin syndrome features, especially after dose changes.
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 Meperidine
- Alvimopan + Meperidine Contraindicated
- Isocarboxazid + Meperidine Contraindicated
- Meperidine + Methylene blue Contraindicated
- Meperidine + Olanzapine / samidorphan Contraindicated
- Meperidine + Phenelzine Contraindicated
- Meperidine + Procarbazine Contraindicated
Other interactions of Doxepin
- Doxepin + Isocarboxazid Contraindicated
- Doxepin + Phenelzine Contraindicated
- Doxepin + Procarbazine Contraindicated
- Doxepin + Safinamide Contraindicated
- Doxepin + Selegiline Contraindicated
- Doxepin + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Doxepin with Meperidine?
MediHelp rates the interaction as major. Doxepin and Meperidine 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. Meperidine has serotonergic activity, and doxepin, a tricyclic antidepressant, can add to this effect. The combination may precipitate serotonin syndrome with agitation, hyperthermia, clonus and autonomic instability. Meperidine can also lower seizure threshold.
How serious is the interaction between Doxepin and Meperidine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer a non-serotonergic opioid such as morphine; if combined, monitor for serotonin syndrome features, especially after dose changes.
What other medicines interact with Meperidine?
MediHelp also lists interactions of Meperidine with, for example, Alvimopan, Isocarboxazid, Methylene blue. The full list is on the Meperidine page.
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