Drug interactions
Esketamine + Tapentadol
Severity: Major
Esketamine and Tapentadol: 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
Tapentadol is an opioid, and combining it with esketamine raises the risk of profound sedation and respiratory depression. Opioid combinations with CNS depressants carry labeled warnings.
What this interaction means in plain words
Esketamine and Tapentadol 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; Tapentadol belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression from mu-opioid agonism plus NMDA antagonism.
What to do
Use the lowest effective doses and monitor respiratory rate and sedation during and after esketamine dosing. Consider timing or dose reduction in vulnerable 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
Other interactions of Tapentadol
- Calcium / magnesium / potassium / sodium oxybates + Tapentadol Contraindicated
- Isocarboxazid + Tapentadol Contraindicated
- Linezolid + Tapentadol Contraindicated
- Methylene blue + Tapentadol Contraindicated
- Olanzapine / samidorphan + Tapentadol Contraindicated
- Phenelzine + Tapentadol Contraindicated
Frequently asked questions
Can I take Esketamine with Tapentadol?
MediHelp rates the interaction as major. Esketamine and Tapentadol 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. Tapentadol is an opioid, and combining it with esketamine raises the risk of profound sedation and respiratory depression. Opioid combinations with CNS depressants carry labeled warnings.
How serious is the interaction between Esketamine and Tapentadol?
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 doses and monitor respiratory rate and sedation during and after esketamine dosing. Consider timing or dose reduction in vulnerable 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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