Drug interactions
Milnacipran + Remifentanil
Severity: Moderate
Milnacipran 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
Combining opioids with SNRIs has been linked to serotonin syndrome, although remifentanil has minimal serotonergic activity. Additive sedation may also occur.
What this interaction means in plain words
Milnacipran 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.
Milnacipran belongs to Central Nervous System; Remifentanil belongs to Musculoskeletal.
Why it happens
Possible additive serotonergic effects and additive CNS depression.
What to do
Monitor for neuromuscular excitability, autonomic instability and altered mental status. Treat promptly if serotonin toxicity develops.
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 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 Milnacipran with Remifentanil?
MediHelp rates the interaction as moderate. Milnacipran 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. Combining opioids with SNRIs has been linked to serotonin syndrome, although remifentanil has minimal serotonergic activity. Additive sedation may also occur.
How serious is the interaction between Milnacipran 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 neuromuscular excitability, autonomic instability and altered mental status. Treat promptly if serotonin toxicity develops.
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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