Drug interactions
Hydrocodone + Remifentanil
Severity: Major
Hydrocodone 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
Two mu-opioid agonists together produce additive sedation and respiratory depression, which can progress to coma or death. The risk is highest with high doses, in opioid-naive patients and when other depressants are present.
What this interaction means in plain words
Hydrocodone 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.
Hydrocodone belongs to Musculoskeletal; Remifentanil belongs to Musculoskeletal.
Why it happens
Additive mu-opioid receptor mediated CNS and respiratory depression.
What to do
Use the lowest effective doses for the shortest duration and monitor respiratory rate and sedation continuously. Have naloxone and airway support 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 Remifentanil
- Alvimopan + Remifentanil Contraindicated
- Isocarboxazid + Remifentanil Contraindicated
- Olanzapine / samidorphan + Remifentanil Contraindicated
- Phenelzine + Remifentanil Contraindicated
- Benzhydrocodone / acetaminophen + Remifentanil Major
- Brexanolone + Remifentanil Major
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 Hydrocodone with Remifentanil?
MediHelp rates the interaction as major. Hydrocodone 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. Two mu-opioid agonists together produce additive sedation and respiratory depression, which can progress to coma or death. The risk is highest with high doses, in opioid-naive patients and when other depressants are present.
How serious is the interaction between Hydrocodone 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: Use the lowest effective doses for the shortest duration and monitor respiratory rate and sedation continuously. Have naloxone and airway support available.
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.
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