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:
Some medicines, such as amprenavir, aprepitant, atazanavir, ciprofloxacin, darunavir, diltiazem, dronedarone, fosamprenavir, fosaprepitant, imatinib, or verapamil, 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.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.
1.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. August, 2014.
2.OxyContin (oxycodone hydrochloride) US prescribing information. Perdue Pharma L.P. July, 2012.
3.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.
4.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.
5.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.
6.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.
7.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/D rugInteractionsLabeling/ucm093664.htm. Updated 08/05/2011.
8.This information is based on or an extract from the UW Metabolism and Transport Drug Interaction Database (DIDB) Platform, Copyright University of Washington 1999-2014..