Drug interactions
Esketamine + Hydromorphone
Severity: Major
Esketamine 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
Hydromorphone is a potent opioid that causes sedation and respiratory depression, and esketamine adds its own sedative and dissociative effects. The combination may result in excessive sedation or breathing suppression, especially in opioid-naive or frail patients.
What this interaction means in plain words
Esketamine 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.
Esketamine belongs to Central Nervous System; Hydromorphone belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression from NMDA antagonism combined with mu-opioid receptor agonism.
What to do
Monitor sedation and respiratory rate during the post-dose observation period and minimize the hydromorphone dose. Avoid giving the opioid immediately before the esketamine session where possible.
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
Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Esketamine with Hydromorphone?
MediHelp rates the interaction as major. Esketamine 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. Hydromorphone is a potent opioid that causes sedation and respiratory depression, and esketamine adds its own sedative and dissociative effects. The combination may result in excessive sedation or breathing suppression, especially in opioid-naive or frail patients.
How serious is the interaction between Esketamine 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: Monitor sedation and respiratory rate during the post-dose observation period and minimize the hydromorphone dose. Avoid giving the opioid immediately before the esketamine session where possible.
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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