Drug interactions
Esketamine + Fentanyl transdermal
Severity: Major
Esketamine and Fentanyl transdermal: 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
Patients on a fentanyl patch have continuous opioid exposure, and adding esketamine can increase sedation and the risk of respiratory depression. Fentanyl levels persist for many hours, so the effect can last through the whole treatment session.
What this interaction means in plain words
Esketamine and Fentanyl transdermal 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 agonism and NMDA antagonism.
What to do
Monitor sedation, respiratory rate and oxygen saturation closely after esketamine dosing, and consider extended observation in opioid-tolerant patients. Review whether the opioid dose can be minimized.
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 transdermal?
MediHelp rates the interaction as major. Esketamine and Fentanyl transdermal 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. Patients on a fentanyl patch have continuous opioid exposure, and adding esketamine can increase sedation and the risk of respiratory depression. Fentanyl levels persist for many hours, so the effect can last through the whole treatment session.
How serious is the interaction between Esketamine and Fentanyl transdermal?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sedation, respiratory rate and oxygen saturation closely after esketamine dosing, and consider extended observation in opioid-tolerant patients. Review whether the opioid dose can be minimized.
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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