Drug interactions
Esketamine + Meperidine
Severity: Major
Esketamine and Meperidine: 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
Meperidine is an opioid that causes sedation and respiratory depression, and its metabolite can be neurotoxic. Together with esketamine the sedative effects add up, and meperidine also carries a risk of seizures with accumulation.
What this interaction means in plain words
Esketamine 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.
Esketamine belongs to Central Nervous System; Meperidine belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression from NMDA antagonism combined with mu-opioid agonism.
What to do
Monitor sedation and breathing closely and prefer an alternative opioid if one is needed. Keep meperidine doses minimal and avoid repeated dosing around sessions.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Esketamine and Meperidine, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Esketamine
Other interactions of Meperidine
- Alvimopan + Meperidine Contraindicated
- Isocarboxazid + Meperidine Contraindicated
- Meperidine + Methylene blue Contraindicated
- Meperidine + Olanzapine / samidorphan Contraindicated
- Meperidine + Phenelzine Contraindicated
- Meperidine + Procarbazine Contraindicated
Frequently asked questions
Can I take Esketamine with Meperidine?
MediHelp rates the interaction as major. Esketamine 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 is an opioid that causes sedation and respiratory depression, and its metabolite can be neurotoxic. Together with esketamine the sedative effects add up, and meperidine also carries a risk of seizures with accumulation.
How serious is the interaction between Esketamine 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: Monitor sedation and breathing closely and prefer an alternative opioid if one is needed. Keep meperidine doses minimal and avoid repeated dosing around sessions.
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.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
