Skip to content
My WebMD Sign In, Sign Up

Fentanyl Oralet buccal

Alfentanil; Fentanyl; Oxycodone/Selected CYP3A4 Inhibitors

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:

Serious. These medicines may interact and cause very harmful effects. 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 you may become more drowsy than normal.

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.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.

References:

1.Actiq (fentanyl citrate) Australian prescribing information. Orphan Australia Pty Ltd. November 2, 2002.
2.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. July, 2012.
3.OxyContin (oxycodone hydrochloride) US prescribing information. Perdue Pharma L.P. July, 2012.
4.Liukas A, Hagelberg NM, Kuusniemi K, Neuvonen PJ, Olkkola KT. Inhibition of cytochrome P450 3A by clarithromycin uniformly affects the pharmacokinetics and pharmacodynamics of oxycodone in young and elderly volunteers. J Clin Psychopharmacol 2011 Jun;31(3):302-8.
5.Bartkowski RR, Goldberg ME, Larijani GE, Boerner T. Inhibition of alfentanil metabolism by erythromycin. Clin Pharmacol Ther 1989 Jul; 46(1):99-102.
6.Feierman DE, Lasker JM. Metabolism of fentanyl, a synthetic opioid analgesic, by human liver microsomes. Role of CYP3A4. Drug Metab Dispos 1996 Sep;24(9):932-9.
7.Palkama VJ, Isohanni MH, Neuvonen PJ, Olkkola KT. The effect of intravenous and oral fluconazole on the pharmacokinetics and pharmacodynamics of intravenous alfentanil. Anesth Analg 1998 Jul; 87(1):190-4.
8.Palkama VJ, Neuvonen PJ, Olkkola KT. The CYP 3A4 inhibitor itraconazole has no effect on the pharmacokinetics of i.v. fentanyl. Br J Anaesth 1998 Oct;81(4):598-600.
9.Saari TI, Gronlund J, Hagelberg NM, Neuvonen M, Laine K, Neuvonen PJ, Olkkola KT. Effects of itraconazole on the pharmacokinetics and pharmacodynamics of intravenously and orally administered oxycodone. Eur J Clin Pharmacol 2010 Apr;66(4):387-97.
10.Kummer O, Hammann F, Moser C, Schaller O, Drewe J, Krahenbuhl S. Effect of the inhibition of CYP3A4 or CYP2D6 on the pharmacokinetics and pharmacodynamics of oxycodone. Eur J Clin Pharmacol 2011 Jan;67(1):63-71.
11.Samer CF, Daali Y, Wagner M, Hopfgartner G, Eap CB, Rebsamen MC, Rossier MF, Hochstrasser D, Dayer P, Desmeules JA. The effects of CYP2D6 and CYP3A activities on the pharmacokinetics of immediate release oxycodone. Br J Pharmacol 2010 Jun;160(4):907-18.
12.Samer CF, Daali Y, Wagner M, Hopfgartner G, Eap CB, Rebsamen MC, Rossier MF, Hochstrasser D, Dayer P, Desmeules JA. Genetic polymorphisms and drug interactions modulating CYP2D6 and CYP3A activities have a major effect on oxycodone analgesic efficacy and safety. Br J Pharmacol 2010 Jun; 160(4):919-30.
13.Klees TM, Sheffels P, Dale O, Kharasch ED. Metabolism of alfentanil by cytochrome p4503a (cyp3a) enzymes. Drug Metab Dispos 2005 Mar; 33(3):303-11.
14.Lalovic B, Phillips B, Risler LL, Howald W, Shen DD. Quantitative contribution of CYP2D6 and CYP3A to oxycodone metabolism in human liver and intestinal microsomes. Drug Metab Dispos 2004 Apr;32(4):447-54.
15.Olkkola KT, Palkama VJ, Neuvonen PJ. Ritonavir's role in reducing fentanyl clearance and prolonging its half-life. Anesthesiology 1999 Sep; 91(3):681-5.
16.Nieminen TH, Hagelberg NM, Saari TI, Neuvonen M, Neuvonen PJ, Laine K, Olkkola KT. Oxycodone concentrations are greatly increased by the concomitant use of ritonavir or lopinavir/ritonavir. Eur J Clin Pharmacol 2010 Oct;66(10):977-85.
17.Norvir (ritonavir) Australian prescribing information. Abbott Australasia Pty. Ltd. January 29, 2004.
18.Gronlund J, Saari T, Hagelberg N, Martikainen IK, Neuvonen PJ, Olkkola KT, Laine K. Effect of telithromycin on the pharmacokinetics and pharmacodynamics of oral oxycodone. J Clin Pharmacol 2010 Jan; 50(1):101-8.
19.Kharasch ED, Walker A, Hoffer C, Sheffels P. Intravenous and oral alfentanil as in vivo probes for hepatic and first-pass cytochrome P450 3A activity: noninvasive assessment by use of pupillary miosis. Clin Pharmacol Ther 2004 Nov;76(5):452-66.
20.Kharasch ED, Whittington D, Hoffer C. Influence of hepatic and intestinal cytochrome P4503A activity on the acute disposition and effects of oral transmucosal fentanyl citrate. Anesthesiology 2004 Sep;101(3):729-37.
21.Tateishi T, Krivoruk Y, Ueng YF, Wood AJ, Guengerich FP, Wood M. Identification of human liver cytochrome P-450 3A4 as the enzyme responsible for fentanyl and sufentanil N-dealkylation. Anesth Analg 1996 Jan;82(1):167-72.
22.Saari TI, Laine K, Leino K, Valtonen M, Neuvonen PJ, Olkkola KT. Voriconazole, but not terbinafine, markedly reduces alfentanil clearance and prolongs its half-life. Clin Pharmacol Ther 2006 Nov;80(5):502-8.
23.Saari TI, Laine K, Neuvonen M, Neuvonen PJ, Olkkola KT. Effect of voriconazole and fluconazole on the pharmacokinetics of intravenous fentanyl. Eur J Clin Pharmacol 2008 Jan;64(1):25-30.
24.Hagelberg NM, Nieminen TH, Saari TI, Neuvonen M, Neuvonen PJ, Laine K, Olkkola KT. Voriconazole drastically increases exposure to oral oxycodone. Eur J Clin Pharmacol 2009 Mar;65(3):263-71.
25.Bartkowski RR, McDonnell TE. Prolonged alfentanil effect following erythromycin administration. Anesthesiology 1990 Sep;73(3):566-8.
26.Horton R, Barber C. Opioid-induced respiratory depression resulting from transdermal fentanyl-clarithromycin drug interaction in a patient with advanced COPD. J Pain Symptom Manage 2009 Jun;37(6):e2-5.
27.Hallberg P, Marten L, Wadelius M. Possible fluconazole-fentanyl interaction-a case report. Eur J Clin Pharmacol 2006 Jun;62(6):491-2.
28.Mercadante S, Villari P, Ferrera P. Itraconazole-fentanyl interaction in a cancer patient. J Pain Symptom Manage 2002 Sep;24(3):284-6.
29.Watanabe M, Homma M, Momo K, Okoshi Y, Wada T, Hara A, Chiba S, Kohda Y. Effects of voriconazole co-administration on oxycodone-induced adverse events: a case in the retrospective survey. Eur J Clin Pharmacol 2011 Jan 8.

See 18 Reviews for this Drug. - OR -

Review this Treatment

Find a Drug:

by name or medical condition or shape/color (Pill Identifier)

(for example: aspirin)

(for example: diabetes)

Report Problems to the Food and Drug Administration
 
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Ask the pharmacist

Questions about medications? Get expert answers by video or live chat about allergies, pregnancy, sleep, and more.
See the Ask the Pharmacist event schedule.

Ask a Question

Popular Slideshows & Tools on WebMD

hands on abdomen
Can you catch one?
Woman sitting in front of UV lights
Is yours working?
woman using breath spray
What's causing yours?
womans hand on abdomen
Are you ready for baby?
MS Overview
Recognizing symptoms.
bowl of yogurt with heart shape
Eat for a healthy heart.
woman doing pushups
To help you get fit.
Colored x-ray of tooth decay
Know what to look for.
Woman sitting with child
Do you know the symptoms?
mosquito
Stings, bites, burns, and more.
Allentown, PA
Are you living in one?
Thyroid exam
See how much you know.

Women's Health Newsletter

Find out what women really need.

WebMD the app

Get trusted health information. Whenever. Wherever... with your iPhone, iPad or Android.

Find Out More

IMPORTANT: About This Section and Other User-Generated Content on WebMD

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatment or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment.

Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.