Drug interactions
Fentanyl transmucosal + Verapamil
Severity: Major
Fentanyl transmucosal and Verapamil: 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
Verapamil may increase systemic fentanyl exposure from transmucosal products by blocking its CYP3A4 metabolism. The result can be deeper and longer sedation and respiratory depression.
What this interaction means in plain words
Fentanyl transmucosal and Verapamil 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
Verapamil inhibits CYP3A4-mediated fentanyl metabolism, reducing clearance.
What to do
Monitor for respiratory depression and sedation at frequent intervals and adjust the fentanyl dose accordingly. Consider an alternative calcium channel blocker or opioid if the combination is not well tolerated.
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 Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
Frequently asked questions
Can I take Fentanyl transmucosal with Verapamil?
MediHelp rates the interaction as major. Fentanyl transmucosal and Verapamil 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. Verapamil may increase systemic fentanyl exposure from transmucosal products by blocking its CYP3A4 metabolism. The result can be deeper and longer sedation and respiratory depression.
How serious is the interaction between Fentanyl transmucosal and Verapamil?
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 for respiratory depression and sedation at frequent intervals and adjust the fentanyl dose accordingly. Consider an alternative calcium channel blocker or opioid if the combination is not well tolerated.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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