Drug interactions
Hydromorphone + Methadone
Severity: Major
Hydromorphone 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
Combining two full opioid agonists increases the risk of sedation, respiratory depression and overdose. Methadone's long and variable half-life makes accumulation possible, and methadone also prolongs the QT interval.
What this interaction means in plain words
Hydromorphone 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.
Hydromorphone belongs to Musculoskeletal; Methadone belongs to Musculoskeletal.
Why it happens
Additive opioid receptor-mediated CNS and respiratory depression.
What to do
Use only when needed, with careful dose titration and monitoring of sedation and respiration. Monitor ECG if QT risk factors are present.
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 Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
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 Hydromorphone with Methadone?
MediHelp rates the interaction as major. Hydromorphone 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. Combining two full opioid agonists increases the risk of sedation, respiratory depression and overdose. Methadone's long and variable half-life makes accumulation possible, and methadone also prolongs the QT interval.
How serious is the interaction between Hydromorphone 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: Use only when needed, with careful dose titration and monitoring of sedation and respiration. Monitor ECG if QT risk factors are present.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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