Drug interactions
Promethazine + Tapentadol
Severity: Major
Promethazine and Tapentadol: 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
Promethazine and the opioid tapentadol both cause CNS depression, so combining them increases the risk of marked sedation, respiratory depression and hypotension.
What this interaction means in plain words
Promethazine and Tapentadol 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.
Promethazine belongs to Respiratory; Tapentadol belongs to Musculoskeletal.
Why it happens
Additive CNS and respiratory depression from opioid receptor agonism and H1 antagonism.
What to do
Use the lowest effective doses and monitor respiratory rate and sedation, especially at initiation. Avoid other CNS depressants such as alcohol and benzodiazepines.
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 Promethazine
- Ibutilide + Promethazine Contraindicated
- Pimozide + Promethazine Contraindicated
- Promethazine + Thioridazine Contraindicated
- Alfentanil + Promethazine Major
- Amiodarone + Promethazine Major
- Amisulpride + Promethazine Major
Other interactions of Tapentadol
- Calcium / magnesium / potassium / sodium oxybates + Tapentadol Contraindicated
- Isocarboxazid + Tapentadol Contraindicated
- Linezolid + Tapentadol Contraindicated
- Methylene blue + Tapentadol Contraindicated
- Olanzapine / samidorphan + Tapentadol Contraindicated
- Phenelzine + Tapentadol Contraindicated
Frequently asked questions
Can I take Promethazine with Tapentadol?
MediHelp rates the interaction as major. Promethazine and Tapentadol 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. Promethazine and the opioid tapentadol both cause CNS depression, so combining them increases the risk of marked sedation, respiratory depression and hypotension.
How serious is the interaction between Promethazine and Tapentadol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective doses and monitor respiratory rate and sedation, especially at initiation. Avoid other CNS depressants such as alcohol and benzodiazepines.
What other medicines interact with Promethazine?
MediHelp also lists interactions of Promethazine with, for example, Ibutilide, Pimozide, Thioridazine. The full list is on the Promethazine page.
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