Selected Opioids/Selected Moderate CYP3A4 Inhibitors Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Your other medicine may slow down how quickly your liver processes your pain medicine.

What might happen:

The amount of pain medicine in your blood may increase and cause more side effects than expected.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to adjust the dose of your medicine or monitor its effects more closely.If you have unusually slow or shallow breathing, get help right away. If you feel more sleepy or tired than normal, contact your healthcare professional as soon as possible.Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, slow heartbeat, coma.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. October, 2019.
  • 2.Demerol (meperidine hydrochloride) US prescribing information. Validus Pharmaceuticals LLC. December, 2023.
  • 3.OxyContin (oxycodone hydrochloride) US prescribing information. Perdue Pharma L.P. October, 2021.
  • 4.Dsuvia (sufentanil) sublingual tablet US prescribing information. AcelRx Pharmaceuticals, Inc. December, 2023.
  • 5.Nitahara K, Matsunaga M, Katori K, Yotsui H, Higuchi H, Higa K. Effect of continuous low-dose intravenous diltiazem on epidural fentanyl analgesia after lower abdominal surgery. Br J Anaesth 2003 Apr;90(4):507-9.
  • 6.USFood and Drug Administration. FDA Drug Safety Communication: FDA updates prescribing information for all opioid pain medicines to provide additional guidance for safe use. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-prescri bing-information-all-opioid-pain-medicines-provide-additional-guidance-saf e-use?utm_medium=email&utm_source=govdelivery April 13, 2023.
  • 7.USFood and Drug Administration. FDA Drug Safety Communication: FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-heal th-care-professionals-discuss-naloxone-all-patients-when-prescribing-opioi d-pain July 23, 2020.
  • 8.Ahonen J, Olkkola KT, Salmenpera M, Hynynen M, Neuvonen PJ. Effect of diltiazem on midazolam and alfentanil disposition in patients undergoing coronary artery bypass grafting. Anesthesiology 1996 Dec;85(6):1246-52.
  • 9.Kapur PA, Norel EJ, Dajee H, Cohen G, Flacke W. Haemodynamic effects of verapamil administration after large doses of fentanyl in man. Can Anaesth Soc J 1986 Mar;33(2):138-44.
  • 10.Levin TT, Bakr MH, Nikolova T. Case report: delirium due to a diltiazem-fentanyl CYP3A4 drug interaction. Gen Hosp Psychiatry 2010 Nov-Dec;32(6):648.e9-648.e10.
  • 11.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and -drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.
  • 12.This information is based on an extract from the Certara Drug Interaction Database (DIDB) Platform, Copyright Certara 1999-2023..
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.