Drug interactions
Fentanyl + Mitotane
Severity: Moderate
Fentanyl and Mitotane: moderate 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
Mitotane is a potent CYP3A4 inducer that can markedly lower fentanyl concentrations, causing loss of analgesia or withdrawal in dependent patients. Induction persists for weeks after stopping mitotane, then fentanyl exposure rises.
What this interaction means in plain words
Fentanyl and Mitotane can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Fentanyl belongs to Musculoskeletal; Mitotane belongs to Oncology.
Why it happens
Mitotane induces CYP3A4, increasing fentanyl metabolism.
What to do
Titrate fentanyl to analgesic response and monitor for withdrawal. When mitotane is stopped, reduce the fentanyl dose and monitor for respiratory depression.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Fentanyl with Mitotane?
MediHelp rates the interaction as moderate. Fentanyl and Mitotane can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Mitotane is a potent CYP3A4 inducer that can markedly lower fentanyl concentrations, causing loss of analgesia or withdrawal in dependent patients. Induction persists for weeks after stopping mitotane, then fentanyl exposure rises.
How serious is the interaction between Fentanyl and Mitotane?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate fentanyl to analgesic response and monitor for withdrawal. When mitotane is stopped, reduce the fentanyl dose and monitor for respiratory depression.
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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