Drug interactions
Esketamine + Levorphanol
Severity: Major
Esketamine and Levorphanol: 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
Levorphanol is a potent opioid, and with esketamine it may cause profound sedation and respiratory depression. Both drugs may cause hypotension or confusion.
What this interaction means in plain words
Esketamine and Levorphanol 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
Use the lowest effective opioid dose and monitor sedation, respiratory rate and oxygen saturation closely after each esketamine dose. Consider extended observation in opioid-tolerant patients.
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 Levorphanol?
MediHelp rates the interaction as major. Esketamine and Levorphanol 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. Levorphanol is a potent opioid, and with esketamine it may cause profound sedation and respiratory depression. Both drugs may cause hypotension or confusion.
How serious is the interaction between Esketamine and Levorphanol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective opioid dose and monitor sedation, respiratory rate and oxygen saturation closely after each esketamine dose. Consider extended observation in opioid-tolerant patients.
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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