Drug interactions
Fentanyl transmucosal + Hydrocodone
Severity: Major
Fentanyl transmucosal and Hydrocodone: 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
Combining hydrocodone with transmucosal fentanyl adds to opioid respiratory and CNS depression. This can lead to profound sedation, coma and death, particularly in patients not opioid tolerant.
What this interaction means in plain words
Fentanyl transmucosal and Hydrocodone 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
Use only in opioid-tolerant patients with a clear need, at the lowest doses. Monitor for sedation and respiratory depression and keep naloxone available.
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 Hydrocodone
- Alvimopan + Hydrocodone Contraindicated
- Bupropion-naltrexone + Hydrocodone Contraindicated
- Hydrocodone + Isocarboxazid Contraindicated
- Hydrocodone + Olanzapine / samidorphan Contraindicated
- Hydrocodone + Phenelzine Contraindicated
- Alfentanil + Hydrocodone Major
Frequently asked questions
Can I take Fentanyl transmucosal with Hydrocodone?
MediHelp rates the interaction as major. Fentanyl transmucosal and Hydrocodone 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. Combining hydrocodone with transmucosal fentanyl adds to opioid respiratory and CNS depression. This can lead to profound sedation, coma and death, particularly in patients not opioid tolerant.
How serious is the interaction between Fentanyl transmucosal and Hydrocodone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use only in opioid-tolerant patients with a clear need, at the lowest doses. Monitor for sedation and respiratory depression and keep naloxone available.
What other medicines interact with Hydrocodone?
MediHelp also lists interactions of Hydrocodone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydrocodone page.
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