Drug interactions
Esketamine intranasal + Fentanyl
Severity: Major
Esketamine intranasal and Fentanyl: major interaction.
Last updated
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
Both agents can cause sedation, and opioids may add to the dissociation, drowsiness and respiratory effects seen after esketamine dosing. The risk is greater in patients with limited respiratory reserve.
What this interaction means in plain words
Esketamine intranasal and Fentanyl 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 pharmacodynamic CNS and respiratory depression.
What to do
Reserve the combination for patients with no adequate alternatives and monitor sedation and oxygen saturation for the whole post-dose observation period. Consider lowering the opioid dose.
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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Other interactions of Fentanyl
- Alvimopan + Fentanyl Contraindicated
- Fentanyl + Isocarboxazid Contraindicated
- Fentanyl + Olanzapine / samidorphan Contraindicated
- Fentanyl + Phenelzine Contraindicated
- Fentanyl + Tranylcypromine Contraindicated
- Alfentanil + Fentanyl Major
Frequently asked questions
Can I take Esketamine intranasal with Fentanyl?
MediHelp rates the interaction as major. Esketamine intranasal and Fentanyl 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. Both agents can cause sedation, and opioids may add to the dissociation, drowsiness and respiratory effects seen after esketamine dosing. The risk is greater in patients with limited respiratory reserve.
How serious is the interaction between Esketamine intranasal and Fentanyl?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reserve the combination for patients with no adequate alternatives and monitor sedation and oxygen saturation for the whole post-dose observation period. Consider lowering the opioid dose.
What other medicines interact with Fentanyl?
MediHelp also lists interactions of Fentanyl with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Fentanyl page.
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