DRUG INTERACTIONS Drug Interactions
Central Nervous System Depressants
The concomitant use of other central nervous system depressants, including other opioids, sedatives, hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants, sedating antihistamines, or alcoholic beverages, may produce additive depressant effects. Hypoventilation, hypotension, profound sedation, coma, or death may occur. Therefore, use of concomitant CNS depressants requires individual adjustment of dosage of the concomitant medication and observation of a given patient.
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OVERDOSAGE
Clinical Presentation
The manifestations of fentanyl overdosage are an extension of its pharmacologic actions, with the most serious effect being respiratory depression.
Treatment
For the management of respiratory depression, immediate countermeasures include removing IONSYS™ and discontinuing administration of any other opiates until the episode has resolved, as well as physically or verbally stimulating the patient. If needed, these actions can be followed by administration of a specific narcotic antagonist such as naloxone. Reversal of the narcotic effect may result in acute onset of pain and the release of catecholamines.
If the clinical situation warrants, ensure a patent airway is established and maintained, administer oxygen and assist or control respiration as indicated, and use an oropharyngeal airway or endotracheal tube if necessary. Adequate body temperature and fluid intake should be maintained.
If severe or persistent hypotension occurs, the possibility of hypovolemia should be considered and managed with appropriate parenteral fluid therapy.
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