A nurse is caring for a client who is receiving meperidine

All Interactions Sort By: SeverityName

Contraindicated (12)

• alvimopan

  alvimopan, meperidine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

• isocarboxazid

  isocarboxazid and meperidine both increase serotonin levels. Contraindicated.isocarboxazid increases toxicity of meperidine by unknown mechanism. Contraindicated.

• linezolid

  linezolid increases toxicity of meperidine by unknown mechanism. Contraindicated.

• nirmatrelvir

  nirmatrelvir will increase the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• phenelzine

  phenelzine and meperidine both increase serotonin levels. Contraindicated.phenelzine increases toxicity of meperidine by unknown mechanism. Contraindicated.

• procarbazine

  procarbazine and meperidine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.procarbazine increases toxicity of meperidine by unknown mechanism. Contraindicated. MAOIs may potentiate CNS depression and hypotension. Do not use meperidine within 14 days of MAOI use. .

• rasagiline

  rasagiline and meperidine both increase serotonin levels. Contraindicated. Risk of serious, sometimes fatal reactions from serotonin syndrome.

• safinamide

  meperidine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.

• selegiline

  selegiline and meperidine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of analgesic.

• selegiline transdermal

  selegiline transdermal increases toxicity of meperidine by unknown mechanism. Contraindicated.

• tranylcypromine

  tranylcypromine and meperidine both increase serotonin levels. Contraindicated.tranylcypromine increases toxicity of meperidine by unknown mechanism. Contraindicated.

Serious - Use Alternative (59)

• amitriptyline

  amitriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• buprenorphine

  buprenorphine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• buprenorphine buccal

  buprenorphine buccal, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• buspirone

  buspirone and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• butorphanol

  butorphanol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• calcium/magnesium/potassium/sodium oxybates

  meperidine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• cimetidine

  cimetidine increases effects of meperidine by decreasing metabolism. Avoid or Use Alternate Drug.

• citalopram

  meperidine, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine

  clonidine, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• cyclobenzaprine

  meperidine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• desipramine

  desipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  meperidine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromethorphan

  dextromethorphan and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• diazepam intranasal

  diazepam intranasal, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• doxepin

  doxepin and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• duloxetine

  duloxetine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• eluxadoline

  meperidine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

• escitalopram

  escitalopram and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.meperidine, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl

  fentanyl, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  fentanyl intranasal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  fentanyl transdermal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  fentanyl transmucosal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fluoxetine

  fluoxetine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.meperidine, fluoxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• hydrocodone

  hydrocodone, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• imipramine

  imipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• levomilnacipran

  levomilnacipran and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and meperidine both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.meperidine, linezolid. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• lofepramine

  lofepramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• lorcaserin

  meperidine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• maprotiline

  maprotiline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• methylene blue

  methylene blue and meperidine both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• metoclopramide intranasal

  meperidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• milnacipran

  milnacipran and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• nalbuphine

  nalbuphine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• nefazodone

  nefazodone and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• nortriptyline

  nortriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod and meperidine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paroxetine

  paroxetine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.meperidine, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• pentazocine

  pentazocine, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• protriptyline

  protriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline transdermal

  selegiline transdermal and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  selinexor, meperidine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• sertraline

  sertraline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.meperidine, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• sodium oxybate

  meperidine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• St John's Wort

  meperidine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• sufentanil SL

  sufentanil SL, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• tedizolid

  tedizolid, meperidine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• tipranavir

  tipranavir, meperidine. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Meperidine levels decrease, but metabolite normeperidine levels increase, increasing risk of seizure.

• tramadol

  tramadol, meperidine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

• trazodone

  trazodone and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• trimipramine

  trimipramine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• valerian

  valerian and meperidine both increase sedation. Avoid or Use Alternate Drug.

• venlafaxine

  venlafaxine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilazodone

  meperidine, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vortioxetine

  meperidine, vortioxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

Monitor Closely (223)

• 5-HTP

  5-HTP and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• albuterol

  meperidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  alfentanil and meperidine both increase sedation. Use Caution/Monitor.

• almotriptan

  almotriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  alprazolam and meperidine both increase sedation. Use Caution/Monitor.

• amifampridine

  meperidine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amitriptyline

  meperidine and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and meperidine both increase sedation. Use Caution/Monitor.

• amoxapine

  meperidine and amoxapine both increase sedation. Use Caution/Monitor.

• apomorphine

  meperidine and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  meperidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aripiprazole

  meperidine and aripiprazole both increase sedation. Use Caution/Monitor.meperidine, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• armodafinil

  meperidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  meperidine, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• atazanavir

  atazanavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• azelastine

  azelastine and meperidine both increase sedation. Use Caution/Monitor.

• baclofen

  baclofen and meperidine both increase sedation. Use Caution/Monitor.

• belladonna and opium

  meperidine and belladonna and opium both increase sedation. Use Caution/Monitor.

• benperidol

  meperidine and benperidol both increase sedation. Use Caution/Monitor.

• benzphetamine

  meperidine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brexanolone

  brexanolone, meperidine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and meperidine both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and meperidine both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and meperidine both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  meperidine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• butabarbital

  butabarbital and meperidine both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and meperidine both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and meperidine both increase sedation. Use Caution/Monitor.

• caffeine

  meperidine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and meperidine both increase sedation. Use Caution/Monitor.

• cariprazine

  meperidine, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• carisoprodol

  carisoprodol and meperidine both increase sedation. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and meperidine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and meperidine both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and meperidine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  meperidine and chlorpromazine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and meperidine both increase sedation. Use Caution/Monitor.

• cinnarizine

  cinnarizine and meperidine both increase sedation. Use Caution/Monitor.

• citalopram

  citalopram and meperidine both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.

• clemastine

  clemastine and meperidine both increase sedation. Use Caution/Monitor.

• clobazam

  meperidine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  meperidine and clomipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and meperidine both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and meperidine both increase sedation. Use Caution/Monitor.

• clozapine

  meperidine and clozapine both increase sedation. Use Caution/Monitor.meperidine, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• cocaine

  cocaine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  codeine and meperidine both increase sedation. Use Caution/Monitor.

• cyclizine

  cyclizine and meperidine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and meperidine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and meperidine both increase sedation. Use Caution/Monitor.

• dantrolene

  dantrolene and meperidine both increase sedation. Use Caution/Monitor.

• daridorexant

  meperidine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darunavir

  darunavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• desflurane

  desflurane and meperidine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

• desipramine

  meperidine and desipramine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  meperidine and deutetrabenazine both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine

  dexchlorpheniramine and meperidine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  meperidine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexfenfluramine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dexmedetomidine

  dexmedetomidine and meperidine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  meperidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  meperidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextroamphetamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextroamphetamine transdermal

  meperidine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromoramide

  dextromoramide and meperidine both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and meperidine both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and meperidine both increase sedation. Use Caution/Monitor.

• diethylpropion

  meperidine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and meperidine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and meperidine both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  dihydroergotamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  dihydroergotamine intranasal and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dimenhydrinate

  dimenhydrinate and meperidine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and meperidine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl and meperidine both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and meperidine both increase sedation. Use Caution/Monitor.

• dobutamine

  meperidine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopamine

  meperidine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  meperidine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  meperidine and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  meperidine and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and meperidine both increase sedation. Use Caution/Monitor.

• droperidol

  meperidine and droperidol both increase sedation. Use Caution/Monitor.

• efavirenz

  efavirenz will decrease the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased toxic metabolite formation.

• eletriptan

  eletriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eltrombopag

  eltrombopag increases levels of meperidine by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

• ephedrine

  meperidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  meperidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  meperidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ergotamine

  ergotamine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• esketamine intranasal

  esketamine intranasal, meperidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  estazolam and meperidine both increase sedation. Use Caution/Monitor.

• ethanol

  meperidine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and meperidine both increase sedation. Use Caution/Monitor.

• fenfluramine

  meperidine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.fenfluramine and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• flibanserin

  meperidine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

• fluphenazine

  meperidine and fluphenazine both increase sedation. Use Caution/Monitor.meperidine, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• flurazepam

  flurazepam and meperidine both increase sedation. Use Caution/Monitor.

• formoterol

  meperidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fosamprenavir

  fosamprenavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• frovatriptan

  frovatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone

  meperidine and ganaxolone both increase sedation. Use Caution/Monitor.

• haloperidol

  meperidine and haloperidol both increase sedation. Use Caution/Monitor.meperidine, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• hydromorphone

  hydromorphone and meperidine both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and meperidine both increase sedation. Use Caution/Monitor.

• iloperidone

  meperidine and iloperidone both increase sedation. Use Caution/Monitor.meperidine, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• imipramine

  meperidine and imipramine both increase sedation. Use Caution/Monitor.

• indinavir

  indinavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• isoniazid

  isoniazid and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• isoproterenol

  meperidine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketamine

  ketamine and meperidine both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  meperidine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  L-tryptophan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• lasmiditan

  lasmiditan, meperidine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  lemborexant, meperidine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• levalbuterol

  meperidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levorphanol

  levorphanol and meperidine both increase sedation. Use Caution/Monitor.

• lisdexamfetamine

  meperidine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lithium

  lithium and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• lofepramine

  meperidine and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  meperidine and lofexidine both increase sedation. Use Caution/Monitor.

• lopinavir

  lopinavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.

• loprazolam

  loprazolam and meperidine both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and meperidine both increase sedation. Use Caution/Monitor.

• lormetazepam

  lormetazepam and meperidine both increase sedation. Use Caution/Monitor.

• loxapine

  meperidine and loxapine both increase sedation. Use Caution/Monitor.meperidine, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• loxapine inhaled

  meperidine and loxapine inhaled both increase sedation. Use Caution/Monitor.meperidine, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lsd

  lsd and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• lurasidone

  lurasidone, meperidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.meperidine, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• maprotiline

  meperidine and maprotiline both increase sedation. Use Caution/Monitor.

• marijuana

  meperidine and marijuana both increase sedation. Use Caution/Monitor.

• melatonin

  meperidine and melatonin both increase sedation. Use Caution/Monitor.

• meprobamate

  meperidine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  meperidine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and meperidine both increase sedation. Use Caution/Monitor.

• methadone

  meperidine and methadone both increase sedation. Use Caution/Monitor.

• methamphetamine

  meperidine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and meperidine both increase sedation. Use Caution/Monitor.

• methylenedioxymethamphetamine

  meperidine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midazolam

  midazolam and meperidine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of benzodiazepines and opioids increases risk of respiratory depression. Use only in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required.

• midodrine

  meperidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mirtazapine

  meperidine and mirtazapine both increase sedation. Use Caution/Monitor.meperidine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• modafinil

  meperidine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• molindone

  meperidine, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• morphine

  meperidine and morphine both increase sedation. Use Caution/Monitor.meperidine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• motherwort

  meperidine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  meperidine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  meperidine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  meperidine and nalbuphine both increase sedation. Use Caution/Monitor.

• naratriptan

  naratriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nelfinavir

  nelfinavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• nevirapine

  nevirapine will decrease the level or effect of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased toxic metabolite formation.

• norepinephrine

  meperidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  meperidine and nortriptyline both increase sedation. Use Caution/Monitor.

• olanzapine

  meperidine and olanzapine both increase sedation. Use Caution/Monitor.meperidine, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• oliceridine

  oliceridine, meperidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• opium tincture

  meperidine and opium tincture both increase sedation. Use Caution/Monitor.

• orphenadrine

  orphenadrine and meperidine both increase sedation. Use Caution/Monitor.

• oxazepam

  oxazepam and meperidine both increase sedation. Use Caution/Monitor.

• oxycodone

  meperidine and oxycodone both increase sedation. Use Caution/Monitor.

• oxymorphone

  meperidine and oxymorphone both increase sedation. Use Caution/Monitor.

• paliperidone

  meperidine and paliperidone both increase sedation. Use Caution/Monitor.meperidine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• papaveretum

  meperidine and papaveretum both increase sedation. Use Caution/Monitor.

• papaverine

  meperidine and papaverine both increase sedation. Use Caution/Monitor.

• pegvisomant

  meperidine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

• pentazocine

  meperidine and pentazocine both increase sedation. Use Caution/Monitor.meperidine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pentobarbital

  pentobarbital and meperidine both increase sedation. Use Caution/Monitor.

• perampanel

  perampanel and meperidine both decrease sedation. Use Caution/Monitor.

• perphenazine

  meperidine and perphenazine both increase sedation. Use Caution/Monitor.meperidine, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• phendimetrazine

  meperidine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenobarbital

  phenobarbital and meperidine both increase sedation. Use Caution/Monitor.

• phentermine

  meperidine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  meperidine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  meperidine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• pholcodine

  meperidine and pholcodine both increase sedation. Use Caution/Monitor.

• pimavanserin

  meperidine, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pimozide

  meperidine and pimozide both increase sedation. Use Caution/Monitor.meperidine, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pirbuterol

  meperidine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pregabalin

  pregabalin, meperidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  primidone and meperidine both increase sedation. Use Caution/Monitor.

• prochlorperazine

  meperidine and prochlorperazine both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and meperidine both increase sedation. Use Caution/Monitor.

• propofol

  propofol and meperidine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  meperidine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  meperidine and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  quazepam and meperidine both increase sedation. Use Caution/Monitor.

• quetiapine

  meperidine and quetiapine both increase sedation. Use Caution/Monitor.meperidine, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ramelteon

  meperidine and ramelteon both increase sedation. Use Caution/Monitor.

• remimazolam

  remimazolam, meperidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. aCoadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• risperidone

  meperidine and risperidone both increase sedation. Use Caution/Monitor.meperidine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ritonavir

  ritonavir increases levels of meperidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.

• rizatriptan

  rizatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• salmeterol

  meperidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• SAMe

  meperidine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• scullcap

  meperidine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and meperidine both increase sedation. Use Caution/Monitor.

• sevoflurane

  sevoflurane and meperidine both increase sedation. Use Caution/Monitor.

• shepherd's purse

  meperidine and shepherd's purse both increase sedation. Use Caution/Monitor.

• stiripentol

  stiripentol, meperidine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  meperidine and sufentanil both increase sedation. Use Caution/Monitor.

• sumatriptan

  sumatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  suvorexant and meperidine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tapentadol

  meperidine and tapentadol both increase sedation. Use Caution/Monitor.meperidine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• temazepam

  temazepam and meperidine both increase sedation. Use Caution/Monitor.

• terbutaline

  meperidine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thioridazine

  meperidine and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  meperidine and thiothixene both increase sedation. Use Caution/Monitor.meperidine, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• topiramate

  meperidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  meperidine and tramadol both increase sedation. Use Caution/Monitor.meperidine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• trazodone

  meperidine and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and meperidine both increase sedation. Use Caution/Monitor.

• triclofos

  triclofos and meperidine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  meperidine and trifluoperazine both increase sedation. Use Caution/Monitor.meperidine, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trimipramine

  meperidine and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and meperidine both increase sedation. Use Caution/Monitor.

• xylometazoline

  meperidine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  meperidine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  meperidine and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  meperidine and ziprasidone both increase sedation. Use Caution/Monitor.meperidine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• zolmitriptan

  zolmitriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• zotepine

  meperidine and zotepine both increase sedation. Use Caution/Monitor.

Minor (12)

• brimonidine

  brimonidine increases effects of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• bupropion

  meperidine increases toxicity of bupropion by unspecified interaction mechanism. Minor/Significance Unknown. May lower seizure threshold; keep bupropion dose as low as possible.

• dextroamphetamine

  dextroamphetamine increases effects of meperidine by unspecified interaction mechanism. Minor/Significance Unknown.

• ethotoin

  ethotoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

• eucalyptus

  meperidine and eucalyptus both increase sedation. Minor/Significance Unknown.

• fosphenytoin

  fosphenytoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

• lidocaine

  lidocaine increases toxicity of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

• metoclopramide

  metoclopramide increases effects of meperidine by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Increased CNS depression.metoclopramide increases effects of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• phenytoin

  phenytoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

• ritonavir

  ritonavir decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown. Ritonavir induces the metabolism of meperidine to normeperidine, increasing CNS toxicity.

• sage

  meperidine and sage both increase sedation. Minor/Significance Unknown.

• ziconotide

  ziconotide, meperidine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

• 5-HTP

  Monitor Closely (1)5-HTP and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• albuterol

  Monitor Closely (1)meperidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  Monitor Closely (1)alfentanil and meperidine both increase sedation. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

• alprazolam

  Monitor Closely (1)alprazolam and meperidine both increase sedation. Use Caution/Monitor.

• alvimopan

  Contraindicated (1)alvimopan, meperidine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

• amifampridine

  Monitor Closely (1)meperidine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amitriptyline

  Monitor Closely (1)meperidine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital and meperidine both increase sedation. Use Caution/Monitor.

• amoxapine

  Monitor Closely (1)meperidine and amoxapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amoxapine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

• apomorphine

  Monitor Closely (1)meperidine and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)meperidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (2)meperidine, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

  meperidine and aripiprazole both increase sedation. Use Caution/Monitor.