Affected cytochrome P isoenzymes: Although opiate agonists are contraindicated for use in patients with diarrhea secondary to poisoning or infectious diarrhea, antimotility agents have been used successfully in these patients. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including morphine. Monitor the patient closely if use of St. Moderate Concomitant use of opiate agonists with other central nervous system CNS depressants can potentiate the effects of the opiate and may lead to additive CNS or respiratory depression, profound sedation, or coma. Major Concomitant use of methadone with another CNS depressant can lead to additive respiratory depression, hypotension, profound sedation, or coma.
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Practical aspects of alfentanil infusion.
Moderate Loxapine can potentiate the actions of other Alfeentanil depressants such as opiate agonists. Alfentanil use requires an experienced clinician trained in the use of anesthetic drugs, airway management, and assisted ventilation.
Moderate Monitor for excessive hypotension and sedation during syrinve of lofexidine and alfentanil. Ensure proper placement of the needle when filling the reservoir to avoid accidental overdose. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response.
Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Use caution when using dexpanthenol with drugs that decrease gastrointestinal motility, such as opiate agonists, as it may decrease the effectiveness of dexpanthenol.
Drugs that can cause CNS depression, if used concomitantly with vigabatrin, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness.
Alfentanil rarely stimulates the release of histamine. Alfentanil is a sensitive CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like diltiazem can increase alfentanil exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of alfentanil.
Barbiturates are inducers of CYP3A4, an isoenzyme responsible for the metabolism of alfentanil. Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme responsible for the metabolism of alfentanil. Moderate Consider a reduced dose of alfentanil with frequent monitoring for respiratory depression and sedation if concurrent use of crizotinib is necessary.
Moderate Monitor patients for bradycardia and hypotension when alfentanil is coadministered with isradipine. Prolongation of the gastrointestinal transit time may be the mechanism of the constipating effect.
Concurrent use of nalbuphine with other opiate agonists can cause additive CNS, respiratory, and hypotensive effects. Moderate Lincosamides, which have been shown to exhibit neuromuscular blocking action, can enhance the effects of opiate agonists if used concomitantly, enhancing respiratory depressant effects.
Caution and close monitoring are advised if these drugs are used together. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Bismuth Subsalicylate; Metronidazole; Tetracycline: Plasma concentrations and efficacy of alfentanil may be reduced if these drugs are administered concurrently.
These symptoms could be troublesome in patients with cardiac disease e. Fentanyl decreases propofol requirement for laryngeal mask airway insertion. Alfenyanil valerian derivative, dihydrovaltrate, binds at barbiturate binding sites; valerenic acid has been shown to inhibit enzyme-induced breakdown of GABA in the brain; the non-volatile monoterpenes valepotriates have sedative activity.
Alfentanil is a sensitive CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like nicardipine can increase alfentanil exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of alfentanil.
Practical aspects of alfentanil infusion.
Induction of alfentanil metabolism may take several days. Recovery from respiratory depression following surgery is more rapid with alfentanil than morphine or fentanyl due to a shorter half-life and reduced accumulation in tissues.
Close monitoring of patients is warranted. A number of recently published studies investigating another opiate fentanyl coadministered with propofol for cLMA insertion have suggested alfemtanil fentanyl dose—responses are not so well defined. Moderate Pain medications that contain opiate agonists may intensify CNS depressive adverse effects seen with gabapentin use, such as drowsiness or dizziness.
Scottish Palliative Care Guidelines – Alfentanil
Moderate Concomitant use of alfentanil with other CNS depressants, such as mirtazapine, can potentiate the effects of alfentanil on respiration, alertness, xose blood pressure. Head trauma, increased intracranial pressure, seizure disorder, seizures. If used together, extreme caution is needed, and a reduced tramadol dose is recommended. Major Avoid coadministration of ceritinib with alfentanil due to increased alfentanil exposure.
Moderate Vigabatrin may cause somnolence and fatigue.