Drug interactions
Fentanyl transdermal + Remifentanil
Severity: Major
Fentanyl transdermal and Remifentanil: 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
Remifentanil given to a patient with a fentanyl patch adds to existing opioid effect, increasing sedation, hypotension and respiratory depression. Opioid requirements may differ in tolerant patients, but dosing errors are risky.
What this interaction means in plain words
Fentanyl transdermal and Remifentanil 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 agonism.
What to do
Titrate remifentanil carefully to effect and monitor ventilation and hemodynamics continuously. Account for the ongoing patch dose when planning analgesia.
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 Remifentanil
- Alvimopan + Remifentanil Contraindicated
- Isocarboxazid + Remifentanil Contraindicated
- Olanzapine / samidorphan + Remifentanil Contraindicated
- Phenelzine + Remifentanil Contraindicated
- Benzhydrocodone / acetaminophen + Remifentanil Major
- Brexanolone + Remifentanil Major
Frequently asked questions
Can I take Fentanyl transdermal with Remifentanil?
MediHelp rates the interaction as major. Fentanyl transdermal and Remifentanil 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. Remifentanil given to a patient with a fentanyl patch adds to existing opioid effect, increasing sedation, hypotension and respiratory depression. Opioid requirements may differ in tolerant patients, but dosing errors are risky.
How serious is the interaction between Fentanyl transdermal and Remifentanil?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate remifentanil carefully to effect and monitor ventilation and hemodynamics continuously. Account for the ongoing patch dose when planning analgesia.
What other medicines interact with Remifentanil?
MediHelp also lists interactions of Remifentanil with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Remifentanil page.
Full monographs, dosing and an interaction checker in the MediHelp app
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