Drug interactions
Meperidine + Primidone
Severity: Major
Meperidine and Primidone: 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
Primidone is metabolized to phenobarbital, so its effects with meperidine resemble those of barbiturates, with added sedation and respiratory depression. Enzyme induction can also increase formation of the neurotoxic metabolite normeperidine.
What this interaction means in plain words
Meperidine and Primidone 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; Primidone belongs to Central Nervous System.
Why it happens
Additive CNS depression and CYP induction by primidone and its metabolite phenobarbital, raising normeperidine formation.
What to do
Monitor sedation, respiratory function and signs of normeperidine toxicity such as tremor or seizures. Consider an alternative opioid in patients on long-term primidone.
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 Primidone
- Lorlatinib + Primidone Contraindicated
- Lurasidone + Primidone Contraindicated
- Primidone + Ranolazine Contraindicated
- Primidone + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
- Primidone + Voriconazole Contraindicated
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Meperidine with Primidone?
MediHelp rates the interaction as major. Meperidine and Primidone 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. Primidone is metabolized to phenobarbital, so its effects with meperidine resemble those of barbiturates, with added sedation and respiratory depression. Enzyme induction can also increase formation of the neurotoxic metabolite normeperidine.
How serious is the interaction between Meperidine and Primidone?
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 sedation, respiratory function and signs of normeperidine toxicity such as tremor or seizures. Consider an alternative opioid in patients on long-term primidone.
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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