Drug interactions
Fentanyl + Nalbuphine
Severity: Major
Fentanyl and Nalbuphine: 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
Nalbuphine is a mixed agonist-antagonist that can partly reverse fentanyl analgesia and may precipitate withdrawal in opioid-dependent patients. It also adds to sedation and respiratory depression, although its respiratory effect has a ceiling.
What this interaction means in plain words
Fentanyl and Nalbuphine 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.
Fentanyl belongs to Musculoskeletal; Nalbuphine belongs to Musculoskeletal.
Why it happens
Competitive action at mu receptors, with kappa agonism, causing antagonism of fentanyl effects and additive CNS depression.
What to do
Avoid giving nalbuphine to patients on chronic fentanyl unless used deliberately to reverse opioid effects. Monitor for loss of analgesia, withdrawal symptoms and respiratory depression.
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 Fentanyl and Nalbuphine, 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.
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 Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Frequently asked questions
Can I take Fentanyl with Nalbuphine?
MediHelp rates the interaction as major. Fentanyl and Nalbuphine 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. Nalbuphine is a mixed agonist-antagonist that can partly reverse fentanyl analgesia and may precipitate withdrawal in opioid-dependent patients. It also adds to sedation and respiratory depression, although its respiratory effect has a ceiling.
How serious is the interaction between Fentanyl and Nalbuphine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid giving nalbuphine to patients on chronic fentanyl unless used deliberately to reverse opioid effects. Monitor for loss of analgesia, withdrawal symptoms and 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.
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.
