Drug interactions
Meperidine + Milnacipran
Severity: Major
Meperidine and Milnacipran: 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
Both drugs enhance serotonergic neurotransmission, so combining them can lead to serotonin syndrome. Features include confusion, agitation, hyperreflexia, myoclonus, sweating and fever. Meperidine is the opioid most often implicated among those with serotonergic activity.
What this interaction means in plain words
Meperidine and Milnacipran 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.
Meperidine belongs to Musculoskeletal; Milnacipran belongs to Central Nervous System.
Why it happens
Additive serotonergic activity through meperidine's serotonin reuptake inhibition and milnacipran's serotonin-norepinephrine reuptake inhibition.
What to do
Avoid the combination and choose a non-serotonergic opioid for analgesia. If unavoidable, monitor closely for serotonin toxicity and discontinue both agents if it occurs.
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 Meperidine
- Alvimopan + Meperidine Contraindicated
- Isocarboxazid + Meperidine Contraindicated
- Meperidine + Methylene blue Contraindicated
- Meperidine + Olanzapine / samidorphan Contraindicated
- Meperidine + Phenelzine Contraindicated
- Meperidine + Procarbazine Contraindicated
Other interactions of Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
Frequently asked questions
Can I take Meperidine with Milnacipran?
MediHelp rates the interaction as major. Meperidine and Milnacipran 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. Both drugs enhance serotonergic neurotransmission, so combining them can lead to serotonin syndrome. Features include confusion, agitation, hyperreflexia, myoclonus, sweating and fever. Meperidine is the opioid most often implicated among those with serotonergic activity.
How serious is the interaction between Meperidine and Milnacipran?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and choose a non-serotonergic opioid for analgesia. If unavoidable, monitor closely for serotonin toxicity and discontinue both agents if it occurs.
What other medicines interact with Meperidine?
MediHelp also lists interactions of Meperidine with, for example, Alvimopan, Isocarboxazid, Methylene blue. The full list is on the Meperidine page.
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