Drug interactions
Fentanyl transdermal + Methadone
Severity: Major
Fentanyl transdermal and Methadone: 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
Using methadone with transdermal fentanyl can cause additive sedation, respiratory depression, hypotension, coma and death. Fentanyl patches deliver drug for many hours after removal, so effects persist and are hard to reverse quickly.
What this interaction means in plain words
Fentanyl transdermal and Methadone 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 mu-opioid receptor mediated CNS and respiratory depression.
What to do
Avoid unless alternatives are inadequate; if used, titrate each drug carefully with reduced doses. Monitor for respiratory depression and sedation, especially at initiation and dose changes, and provide naloxone.
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 Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Frequently asked questions
Can I take Fentanyl transdermal with Methadone?
MediHelp rates the interaction as major. Fentanyl transdermal and Methadone 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. Using methadone with transdermal fentanyl can cause additive sedation, respiratory depression, hypotension, coma and death. Fentanyl patches deliver drug for many hours after removal, so effects persist and are hard to reverse quickly.
How serious is the interaction between Fentanyl transdermal and Methadone?
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 unless alternatives are inadequate; if used, titrate each drug carefully with reduced doses. Monitor for respiratory depression and sedation, especially at initiation and dose changes, and provide naloxone.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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