Drug interactions
Fentanyl intranasal + Voriconazole
Severity: Major
Fentanyl intranasal and Voriconazole: 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
Voriconazole inhibits CYP3A4, the main route of fentanyl clearance, which may substantially increase fentanyl levels. This can cause profound sedation and potentially fatal respiratory depression, particularly with prolonged use.
What this interaction means in plain words
Fentanyl intranasal and Voriconazole 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
CYP3A4 inhibition reduces fentanyl metabolism and clearance.
What to do
Monitor frequently for respiratory depression and sedation, and reduce the fentanyl dose until stable. Consider an alternative opioid not dependent on CYP3A4 if prolonged co-therapy is 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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Other interactions of Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole Contraindicated
Frequently asked questions
Can I take Fentanyl intranasal with Voriconazole?
MediHelp rates the interaction as major. Fentanyl intranasal and Voriconazole 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. Voriconazole inhibits CYP3A4, the main route of fentanyl clearance, which may substantially increase fentanyl levels. This can cause profound sedation and potentially fatal respiratory depression, particularly with prolonged use.
How serious is the interaction between Fentanyl intranasal and Voriconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor frequently for respiratory depression and sedation, and reduce the fentanyl dose until stable. Consider an alternative opioid not dependent on CYP3A4 if prolonged co-therapy is needed.
What other medicines interact with Voriconazole?
MediHelp also lists interactions of Voriconazole with, for example, Avanafil, Butabarbital, Carbamazepine. The full list is on the Voriconazole page.
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