Drug interactions
Esketamine + Remifentanil
Severity: Major
Esketamine and Remifentanil: 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
Remifentanil is a potent opioid, and combining it with esketamine increases sedation and the risk of respiratory depression and apnea. Both can also affect blood pressure and heart rate.
What this interaction means in plain words
Esketamine and Remifentanil 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; Remifentanil belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression from mu-opioid agonism plus NMDA receptor antagonism.
What to do
Use only with continuous monitoring of ventilation, oxygenation and hemodynamics, and titrate the opioid to effect with ventilatory support available. Reduce doses as needed.
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 Remifentanil
- Alvimopan + Remifentanil Contraindicated
- Isocarboxazid + Remifentanil Contraindicated
- Olanzapine / samidorphan + Remifentanil Contraindicated
- Phenelzine + Remifentanil Contraindicated
- Benzhydrocodone / acetaminophen + Remifentanil Major
- Brexanolone + Remifentanil Major
Frequently asked questions
Can I take Esketamine with Remifentanil?
MediHelp rates the interaction as major. Esketamine and Remifentanil 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. Remifentanil is a potent opioid, and combining it with esketamine increases sedation and the risk of respiratory depression and apnea. Both can also affect blood pressure and heart rate.
How serious is the interaction between Esketamine and Remifentanil?
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 only with continuous monitoring of ventilation, oxygenation and hemodynamics, and titrate the opioid to effect with ventilatory support available. Reduce doses as needed.
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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