Interactions : אינטראקציות

4.5. Interaction with other medicinal products and other forms of interaction

Remifentanil is not metabolized by plasma cholinesterase; therefore, interactions with drugs metabolized by this enzyme are not expected.

As with other opioids Remifentanil, whether given by manually-controlled infusion, decreases the amounts or doses of inhaled and IV anaesthetics, and benzodiazepines required for anaesthesia (see section 4.2 Posology and method of administration, General Anaesthesia – Adults, Paediatric Patients, and Cardiac Surgery). If doses of concomitantly administered CNS depressant drugs are not reduced, patients may experience an increased incidence of adverse effects associated with these agents.
Sedative medicines such as benzodiazepines or related drugs
The concomitant use of opioids with sedative medicines such as benzodiazepines or related drugs increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. The dose and duration of concomitant use should be limited (see section 4.4).
The concomitant use of opioids and gabapentinoids (gabapentin and pregabalin) increases the risk of opioid overdose, respiratory depression and death. Co-administration of remifentanil with a serotonergic agent, such as Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) or Monoamine Oxidase Inhibitors (MAOIs) may increase the risk of serotonin syndrome, a potentially life- threatening condition. Caution should be exercised with concomitant use of MAOIs.
Irreversible MAOIs should be discontinued at least 2 weeks prior to Remifentanil use.

The cardiovascular effects of Remifentanil (hypotension and bradycardia), may be exacerbated in patients receiving concomitant cardiac depressant drugs, such as beta- blockers and calcium channel blocking agents.