Drug interactions
Milnacipran + Sufentanil sl
Severity: Major
Milnacipran and Sufentanil sl: major interaction.
Last updated Sources: US FDA label
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
Sufentanil has serotonergic activity in addition to opioid effects, and combined with milnacipran it may contribute to serotonin syndrome. Additive CNS depression is also possible.
What this interaction means in plain words
Milnacipran and Sufentanil sl 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.
Why it happens
Additive serotonergic effects of the SNRI and the opioid, plus additive CNS depression.
What to do
Observe closely for agitation, tremor, hyperreflexia, diaphoresis and hyperthermia, especially at initiation and dose changes. Stop one or both drugs if serotonin syndrome is suspected.
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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References
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 Sufentanil sl?
MediHelp rates the interaction as major. Milnacipran and Sufentanil sl 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. Sufentanil has serotonergic activity in addition to opioid effects, and combined with milnacipran it may contribute to serotonin syndrome. Additive CNS depression is also possible.
How serious is the interaction between Milnacipran and Sufentanil sl?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Observe closely for agitation, tremor, hyperreflexia, diaphoresis and hyperthermia, especially at initiation and dose changes. Stop one or both drugs if serotonin syndrome is suspected.
What other medicines interact with Milnacipran?
MediHelp also lists interactions of Milnacipran with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Milnacipran page.
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