Drug interactions
Esketamine + Fentanyl intranasal
Severity: Major
Esketamine and Fentanyl intranasal: major interaction.
Last updated Sources: EMA SmPC
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
Fentanyl is a potent opioid, and combining it with esketamine raises the risk of profound sedation, respiratory depression and hypotension. Both drugs are given by the nasal route, and absorbed doses can overlap in effect.
What this interaction means in plain words
Esketamine 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 CNS and respiratory depression from opioid receptor agonism and NMDA antagonism.
What to do
Avoid concurrent use where possible. If it cannot be avoided, use the lowest effective fentanyl dose and monitor respiratory rate, oxygen saturation and sedation continuously.
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 Esketamine
Frequently asked questions
Can I take Esketamine with Fentanyl intranasal?
MediHelp rates the interaction as major. Esketamine 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. Fentanyl is a potent opioid, and combining it with esketamine raises the risk of profound sedation, respiratory depression and hypotension. Both drugs are given by the nasal route, and absorbed doses can overlap in effect.
How serious is the interaction between Esketamine 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 use where possible. If it cannot be avoided, use the lowest effective fentanyl dose and monitor respiratory rate, oxygen saturation and sedation continuously.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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