meperidine

7.2 Opioid Drugs Because serious, sometimes fatal reactions have been precipitated with concomitant use of opioid drugs (e.g., meperidine and its derivatives, methadone, propoxyphene, or tramadol) and MAOIs, including selective MAO-B inhibitors, concomitant use of these drugs is contraindicated [see Warnings and Precautions (5.2) ] .

Mechanism: This combination can cause a severe, life-threatening reaction by interfering with how the brain handles certain chemicals.

What to do: Avoid taking these medications together under any circumstances.

7 DRUG INTERACTIONS Meperidine: Risk of serotonin syndrome (4, 7.1) Dextromethorphan: Risk of psychosis or bizarre behavior (4, 7.2) MAO inhibitors: Risk of non-selective MAO inhibition and hypertensive crisis (4, 7.3) 7.1 Meperidine Serious, sometimes fatal reactions have been precipitated with concomitant use of meperidine (e.g., Demerol and other tradenames) and MAO inhibitors including selective MAO-B inhibitors [see Contraindications (4)] .

Mechanism: Combining these medications can cause a life-threatening reaction called serotonin syndrome, where a brain chemical reaches dangerously high levels. This can lead to serious or even fatal health problems.

What to do: Do not take these two medications together. Talk to your doctor about safer pain relief options that do not interact with your other medicine.

Product Clinical Comment on Concomitant Use [See Contraindications (4.1)] ; Predominant Effect/Risk [Hypertensive Reaction (HR) [See Warnings and Precautions (5.3)] ; or Serotonin Syndrome (SS) [See Warnings and Precautions (5.7)] ] Altretamine Use with caution If not otherwise specified in this table, consider avoiding concomitant use (see also information on medication-free intervals , use agent at the lowest appropriate dose, monitor for effects of the interaction, advise the patient to report potential effects, and be prepared to discontinue the agent and treat effects of the interactio...

Mechanism: This combination can cause a life-threatening reaction involving very high blood pressure or too much serotonin in the brain. The drugs prevent your body from properly breaking down these powerful chemicals.

What to do: Avoid this combination entirely. If it is used, your healthcare provider must monitor you for signs of a reaction and be ready to stop the medicine.

Examples: Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids (gabapentin or pregabalin), other opioids, alcohol.

Mechanism: Both drugs slow down the central nervous system. This can lead to increased sleepiness, dizziness, or breathing difficulties.

What to do: Your doctor may need to adjust your doses, and you should be monitored for signs of excessive sedation.

Examples: Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that effect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine, metaxalone), monoamine oxidase inhibitors (MAOIs) (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue).

Mechanism: Both drugs increase the level of a brain chemical called serotonin. Too much serotonin can cause a serious reaction called serotonin syndrome.

What to do: Watch for symptoms like confusion, sweating, or a fast heartbeat and seek medical help if they occur.