Drug interactions
Levomilnacipran + Remifentanil
Severity: Moderate
Levomilnacipran and Remifentanil: moderate 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
Opioids with serotonergic activity combined with an SNRI carry a risk of serotonin syndrome. Remifentanil has weak serotonergic effects, so the risk is likely lower than with agents such as tramadol or meperidine.
What this interaction means in plain words
Levomilnacipran and Remifentanil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Levomilnacipran belongs to Central Nervous System; Remifentanil belongs to Musculoskeletal.
Why it happens
Possible additive serotonergic effects from combining an opioid with a serotonin-norepinephrine reuptake inhibitor.
What to do
Monitor for mental status changes, autonomic instability, tremor, clonus and hyperthermia, especially after dose changes. Stop the agents and give supportive care if serotonin syndrome is suspected.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Levomilnacipran with Remifentanil?
MediHelp rates the interaction as moderate. Levomilnacipran and Remifentanil can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Opioids with serotonergic activity combined with an SNRI carry a risk of serotonin syndrome. Remifentanil has weak serotonergic effects, so the risk is likely lower than with agents such as tramadol or meperidine.
How serious is the interaction between Levomilnacipran and Remifentanil?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for mental status changes, autonomic instability, tremor, clonus and hyperthermia, especially after dose changes. Stop the agents and give supportive care if serotonin syndrome is suspected.
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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