pentazocine/acetaminophen (Discontinued)

Pain

Dose determined by pain severity and patient response

1 tablet PO q4hr; not to exceed 6 tablets/day

Renal Impairment

Caution; may need to reduce either dose or frequency of administration

Hepatic Impairment

Caution; may need to reduce either dose or frequency of administration

Pain

Dose determined by pain severity and patient response

<12 years: Safety & efficacy not established

12 years or older: 1 tablet PO q4hr; not to exceed 6 tablets/day

Use caution

Pain

Dose determined by pain severity and patient response

1 tablet PO q4hr; not to exceed 6 tablets/day

Contraindicated (1)

• alvimopan

  alvimopan, pentazocine. 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.

Serious - Use Alternative (49)

• alfentanil

  pentazocine, alfentanil. 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.

• belladonna and opium

  pentazocine, belladonna and opium. 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.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, pentazocine. 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.
  
  pentazocine decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients.
  
  benzhydrocodone/acetaminophen and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• bremelanotide

  bremelanotide will decrease the level or effect of pentazocine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• buprenorphine

  buprenorphine, pentazocine. 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, pentazocine. 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 subdermal implant

  buprenorphine subdermal implant and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  buprenorphine transdermal and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• butorphanol

  butorphanol, pentazocine. 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

  pentazocine, 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 pentazocine by decreasing metabolism. Avoid or Use Alternate Drug.

• clonidine

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

• codeine

  pentazocine, codeine. 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.

• desvenlafaxine

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

• dextromoramide

  pentazocine, dextromoramide. 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.

• diamorphine

  pentazocine, diamorphine. 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.

• diazepam intranasal

  diazepam intranasal, pentazocine. 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.

• difenoxin hcl

  pentazocine, difenoxin hcl. 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.

• diphenoxylate hcl

  pentazocine, diphenoxylate hcl. 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.

• dipipanone

  pentazocine, dipipanone. 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.

• eluxadoline

  pentazocine, 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. .

• fentanyl

  fentanyl, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• fentanyl intranasal

  fentanyl intranasal, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• fentanyl transdermal

  fentanyl transdermal, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• fentanyl transmucosal

  fentanyl transmucosal, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• hydrocodone

  pentazocine decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.
  
  hydrocodone, pentazocine. 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.

• hydromorphone

  pentazocine, hydromorphone. 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.

• isocarboxazid

  isocarboxazid and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  isocarboxazid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• levorphanol

  pentazocine, levorphanol. 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.

• linezolid

  linezolid and pentazocine 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.
  
  linezolid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• lonafarnib

  acetaminophen will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• meperidine

  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.

• methadone

  pentazocine, methadone. 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.

• methylene blue

  methylene blue and pentazocine 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 pentazocine (if possible) 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

  pentazocine, 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.

• morphine

  pentazocine, morphine. 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.

• nalbuphine

  nalbuphine, pentazocine. 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.

• oliceridine

  pentazocine, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.

• olopatadine intranasal

  pentazocine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• opium tincture

  pentazocine, opium tincture. 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.

• oxycodone

  pentazocine, oxycodone. 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.

• oxymorphone

  pentazocine, oxymorphone. 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.

• ozanimod

  ozanimod and pentazocine 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.

• papaveretum

  pentazocine, papaveretum. 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.

• pexidartinib

  acetaminophen and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

• phenelzine

  phenelzine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  phenelzine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• pretomanid

  acetaminophen, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

• procarbazine

  procarbazine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  procarbazine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

Monitor Closely (246)

• 5-HTP

  5-HTP and pentazocine both increase serotonin levels. Use Caution/Monitor.

• acrivastine

  acrivastine and pentazocine both increase sedation. Use Caution/Monitor.

• albuterol

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

• alfentanil

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

• almotriptan

  almotriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• alprazolam

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

• amisulpride

  amisulpride and pentazocine both increase sedation. Use Caution/Monitor.

• amitriptyline

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

• amobarbital

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

• amoxapine

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

• apalutamide

  apalutamide will decrease the level or effect of acetaminophen by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.

• apomorphine

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

• arformoterol

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

• aripiprazole

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

• armodafinil

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

• asenapine

  asenapine and pentazocine both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and pentazocine both increase sedation. Use Caution/Monitor.

• atogepant

  acetaminophen will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• avapritinib

  acetaminophen will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  avapritinib and pentazocine both increase sedation. Use Caution/Monitor.

• axitinib

  acetaminophen increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azelastine

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

• baclofen

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

• belladonna and opium

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

• benperidol

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

• benzphetamine

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

• brexanolone

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

• brexpiprazole

  brexpiprazole and pentazocine both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and pentazocine both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and pentazocine both increase sedation. Use Caution/Monitor.

• brompheniramine

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

• bupivacaine implant

  acetaminophen, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

• buprenorphine

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

• buprenorphine buccal

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

• buprenorphine, long-acting injection

  pentazocine 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.

• buspirone

  buspirone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• busulfan

  acetaminophen increases levels of busulfan by decreasing metabolism. Use Caution/Monitor. Use of acetaminophen prior to (< 72 hours) or concurrently with busulfan may result in decreased clearance of busulfan due to acetaminophen-induced decreases in glutathione levels.

• butabarbital

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

• butalbital

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

• butorphanol

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

• caffeine

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

• carbinoxamine

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

• carisoprodol

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

• cenobamate

  cenobamate, pentazocine. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

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

• chlordiazepoxide

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

• chlorpheniramine

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

• chlorpromazine

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

• chlorzoxazone

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

• cigarette smoking

  cigarette smoking decreases effects of pentazocine by increasing metabolism. Use Caution/Monitor. Tobacco smoking may decrease the clinical effect of a standard pentazocine dose.

• cinnarizine

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

• citalopram

  citalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• clemastine

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

• clomipramine

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

• clonazepam

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

• clorazepate

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

• clozapine

  pentazocine and clozapine both increase sedation. Use Caution/Monitor.

• cocaine topical

  cocaine topical and pentazocine both increase serotonin levels. Use Caution/Monitor.

• codeine

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

• cyclizine

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

• cyclobenzaprine

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

• cyproheptadine

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

• dantrolene

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

• dapsone topical

  acetaminophen increases toxicity of dapsone topical by altering metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia .

• daridorexant

  pentazocine 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.

• desflurane

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

• desipramine

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

• deutetrabenazine

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

• dexchlorpheniramine

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

• dexfenfluramine

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

• dexmedetomidine

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

• dexmethylphenidate

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

• dextroamphetamine

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

• dextromethorphan

  dextromethorphan and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextromoramide

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

• diamorphine

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

• diazepam

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

• diethylpropion

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

• difelikefalin

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

• difenoxin hcl

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

• dihydroergotamine

  dihydroergotamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• dihydroergotamine intranasal

  dihydroergotamine intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.

• dimenhydrinate

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

• diphenhydramine

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

• diphenoxylate hcl

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

• dipipanone

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

• dobutamine

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

• dopamine

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

• dopexamine

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

• dosulepin

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

• doxepin

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

• doxylamine

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

• droperidol

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

• duloxetine

  duloxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eletriptan

  eletriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• eltrombopag

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

• ephedrine

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

• epinephrine

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

• epinephrine racemic

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

• ergotamine

  ergotamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• escitalopram

  escitalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• esketamine intranasal

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

• estazolam

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

• ethanol

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

• etomidate

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

• exenatide injectable solution

  exenatide injectable solution will decrease the level or effect of acetaminophen by unspecified interaction mechanism. Use Caution/Monitor. To avoid potential interaction, give acetaminophen at least 1 hour before or 4 hours after exenatide injection.

• exenatide injectable suspension

  exenatide injectable suspension will decrease the level or effect of acetaminophen by unspecified interaction mechanism. Use Caution/Monitor. To avoid potential interaction, give acetaminophen at least 1 hour before or 4 hours after exenatide injection.

• fenfluramine

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

• finerenone

  acetaminophen will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

• flibanserin

  pentazocine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
  
  acetaminophen will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

• fluoxetine

  fluoxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• imatinib

  imatinib decreases levels of acetaminophen by decreasing hepatic clearance. Modify Therapy/Monitor Closely. In vitro, imatinib was found to inhibit acetaminophen O-glucuronidation (Ki value of 58.5 micro-M) at therapeutic levels; avoid chronic acetaminophen therapy with imatinib; if occasional acetaminophen administered, do not exceed 1300 mg/day.

• fluphenazine

  pentazocine and fluphenazine both increase sedation. Use Caution/Monitor.

• flurazepam

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

• fluvoxamine

  fluvoxamine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• formoterol

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

• frovatriptan

  frovatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• gabapentin

  gabapentin, pentazocine. 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, pentazocine. 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

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

• haloperidol

  pentazocine and haloperidol both increase sedation. Use Caution/Monitor.

• hydromorphone

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

• hydroxyzine

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

• iloperidone

  pentazocine and iloperidone both increase sedation. Use Caution/Monitor.

• imipramine

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

• isavuconazonium sulfate

  acetaminophen will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isoniazid

  isoniazid and pentazocine both increase serotonin levels. Use Caution/Monitor.
  
  isoniazid will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.

• isoproterenol

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

• ivacaftor

  acetaminophen increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

• ketamine

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

• ketotifen, ophthalmic

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

• L-tryptophan

  L-tryptophan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• lasmiditan

  lasmiditan, pentazocine. 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, pentazocine. 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.
  
  acetaminophen will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

• levalbuterol

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

• levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

  levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will decrease the level or effect of acetaminophen by unknown mechanism. Use Caution/Monitor.
  
  acetaminophen increases levels of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by decreasing hepatic clearance. Use Caution/Monitor. Coadministration of ascorbic acid and certain combined hormonal contraceptives (CHCs) containing EE may increase plasma EE concentrations, possibly by inhibition of conjugation.

• levomilnacipran

  levomilnacipran and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• levorphanol

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

• lisdexamfetamine

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

• lithium

  lithium and pentazocine both increase serotonin levels. Use Caution/Monitor.

• lixisenatide (DSC)

  lixisenatide (DSC) will decrease the level or effect of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. GLP1 agonists delay gastric emptying, which may affect absorption of concomitantly administered oral medications. No effects on acetaminophen Cmax and Tmax were observed when acetaminophen was administered 1 hr before lixisenatide. When administered 1 or 4 hr after lixisenatide, acetaminophen Cmax was decreased by 29% and 31% respectively and median Tmax was delayed by 2 and 1.75 hr, respectively.

• lofepramine

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

• lofexidine

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

• lomitapide

  acetaminophen increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• loprazolam

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

• lorazepam

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

• lormetazepam

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

• loxapine

  pentazocine and loxapine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  pentazocine and loxapine inhaled both increase sedation. Use Caution/Monitor.

• lsd

  lsd and pentazocine both increase serotonin levels. Use Caution/Monitor.

• lurasidone

  lurasidone, pentazocine. 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.

• maprotiline

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

• marijuana

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

• melatonin

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

• meperidine

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

• meprobamate

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

• metaproterenol

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

• metaxalone

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

• methadone

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

• methamphetamine

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

• methocarbamol

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

• methylenedioxymethamphetamine

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

• midazolam

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

• midazolam intranasal

  midazolam intranasal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
  
  acetaminophen will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

• midodrine

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

• mipomersen

  mipomersen, acetaminophen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• milnacipran

  milnacipran and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• mirtazapine

  pentazocine and mirtazapine both increase sedation. Use Caution/Monitor.
  
  mirtazapine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• modafinil

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

• morphine

  morphine and pentazocine both increase sedation. Use Caution/Monitor.
  
  morphine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• motherwort

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

• moxonidine

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

• nabilone

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

• nalbuphine

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

• naratriptan

  naratriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• nefazodone

  nefazodone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• norepinephrine

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

• nortriptyline

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

• olanzapine

  pentazocine and olanzapine both increase sedation. Use Caution/Monitor.

• oliceridine

  oliceridine, pentazocine. 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

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

• orphenadrine

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

• oxazepam

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

• oxycodone

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

• oxymorphone

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

• paliperidone

  pentazocine and paliperidone both increase sedation. Use Caution/Monitor.

• papaveretum

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

• papaverine

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

• paroxetine

  paroxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pegvisomant

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

• pentobarbital

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

• perphenazine

  pentazocine and perphenazine both increase sedation. Use Caution/Monitor.

• phendimetrazine

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

• phenobarbital

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

• phentermine

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

• phenylephrine

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

• phenylephrine PO

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

• pholcodine

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

• pimozide

  pentazocine and pimozide both increase sedation. Use Caution/Monitor.

• pirbuterol

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

• pregabalin

  pregabalin, pentazocine. 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 pentazocine both increase sedation. Use Caution/Monitor.

• prochlorperazine

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

• promethazine

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

• propofol

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

• propylhexedrine

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

• protriptyline

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

• quazepam

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

• quetiapine

  pentazocine and quetiapine both increase sedation. Use Caution/Monitor.

• ramelteon

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

• remimazolam

  remimazolam, pentazocine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration 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

  pentazocine and risperidone both increase sedation. Use Caution/Monitor.

• rizatriptan

  rizatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• salmeterol

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

• SAMe

  pentazocine and SAMe both increase serotonin levels. Use Caution/Monitor.

• scullcap

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

• secobarbital

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

• selegiline

  selegiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.

• selegiline transdermal

  selegiline transdermal and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sertraline

  sertraline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sevoflurane

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

• shepherd's purse

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

• St John's Wort

  pentazocine and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.

• stiripentol

  stiripentol, pentazocine. 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

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

• sumatriptan

  sumatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• sumatriptan intranasal

  sumatriptan intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.

• suvorexant

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

• tapentadol

  pentazocine and tapentadol both increase sedation. Use Caution/Monitor.

• tazemetostat

  acetaminophen will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• temazepam

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

• terbutaline

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

• tetracaine

  tetracaine, acetaminophen. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

• thioridazine

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

• thiothixene

  pentazocine and thiothixene both increase sedation. Use Caution/Monitor.

• tinidazole

  acetaminophen will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• topiramate

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

• tramadol

  pentazocine and tramadol both increase sedation. Use Caution/Monitor.
  
  pentazocine and tramadol both increase serotonin levels. Use Caution/Monitor.

• trazodone

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

• triazolam

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

• triclofos

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

• trifluoperazine

  pentazocine and trifluoperazine both increase sedation. Use Caution/Monitor.

• trimipramine

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

• triprolidine

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

• venlafaxine

  venlafaxine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• warfarin

  acetaminophen increases effects of warfarin by anticoagulation. Use Caution/Monitor.

• xylometazoline

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

Minor (58)

• acetazolamide

  acetazolamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• albiglutide

  albiglutide decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• antithrombin alfa

  acetaminophen increases effects of antithrombin alfa by unknown mechanism. Minor/Significance Unknown.

• antithrombin III

  acetaminophen increases effects of antithrombin III by unknown mechanism. Minor/Significance Unknown.

• argatroban

  acetaminophen increases effects of argatroban by unknown mechanism. Minor/Significance Unknown.

• aspirin

  aspirin, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• aspirin rectal

  aspirin rectal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• aspirin/citric acid/sodium bicarbonate

  aspirin/citric acid/sodium bicarbonate, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• bemiparin

  acetaminophen increases effects of bemiparin by unknown mechanism. Minor/Significance Unknown.

• bivalirudin

  acetaminophen increases effects of bivalirudin by unknown mechanism. Minor/Significance Unknown.

• brimonidine

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

• carbamazepine

  carbamazepine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• cholestyramine

  cholestyramine decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• clonazepam

  clonazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• colestipol

  colestipol decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• dalteparin

  acetaminophen increases effects of dalteparin by unknown mechanism. Minor/Significance Unknown.

• dextroamphetamine

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

• diazepam

  diazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• disulfiram

  disulfiram will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• enoxaparin

  acetaminophen increases effects of enoxaparin by unknown mechanism. Minor/Significance Unknown.

• ethanol

  ethanol will decrease the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen by decreasing metabolism. Minor/Significance Unknown.

• ethosuximide

  ethosuximide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• eucalyptus

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

• felbamate

  felbamate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• fondaparinux

  acetaminophen increases effects of fondaparinux by unknown mechanism. Minor/Significance Unknown.

• fosphenytoin

  fosphenytoin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• green tea

  green tea increases effects of acetaminophen by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical, due to caffeine content).

• heparin

  acetaminophen increases effects of heparin by unknown mechanism. Minor/Significance Unknown.

• isoniazid

  isoniazid increases toxicity of acetaminophen by unknown mechanism. Minor/Significance Unknown.

• lacosamide

  lacosamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• lamotrigine

  lamotrigine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• levetiracetam

  levetiracetam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• lidocaine

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

• liraglutide

  liraglutide decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• lorazepam

  lorazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• methsuximide

  methsuximide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• metoclopramide

  metoclopramide increases levels of acetaminophen by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• metronidazole

  metronidazole will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• oxcarbazepine

  oxcarbazepine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• oxybutynin

  oxybutynin decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin topical

  oxybutynin topical decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin transdermal

  oxybutynin transdermal decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• phenindione

  acetaminophen increases effects of phenindione by unknown mechanism. Minor/Significance Unknown.

• phenobarbital

  phenobarbital decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• phenytoin

  phenytoin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• primidone

  primidone decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• protamine

  acetaminophen increases effects of protamine by unknown mechanism. Minor/Significance Unknown.

• rifabutin

  rifabutin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• rifampin

  rifampin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• rufinamide

  rufinamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• ruxolitinib

  acetaminophen will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  acetaminophen will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage

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

• tiagabine

  tiagabine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• topiramate

  topiramate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• valproic acid

  valproic acid decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• ziconotide

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

• zonisamide

  zonisamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism increase levels of hepatotoxic metabolites.

• 5-HTP

  Monitor Closely (1)5-HTP and pentazocine both increase serotonin levels. Use Caution/Monitor.

• acetazolamide

  Minor (1)acetazolamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• acrivastine

  Monitor Closely (1)acrivastine and pentazocine both increase sedation. Use Caution/Monitor.

• albiglutide

  Minor (1)albiglutide decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• albuterol

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

• alfentanil

  Monitor Closely (1)alfentanil and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, alfentanil. 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.

• almotriptan

  Monitor Closely (1)almotriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• alprazolam

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

• alvimopan

  Contraindicated (1)alvimopan, pentazocine. 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.

• amisulpride

  Monitor Closely (1)amisulpride and pentazocine both increase sedation. Use Caution/Monitor.

• amitriptyline

  Monitor Closely (2)amitriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital

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

• amoxapine

  Monitor Closely (2)amoxapine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and amoxapine both increase sedation. Use Caution/Monitor.

• antithrombin alfa

  Minor (1)acetaminophen increases effects of antithrombin alfa by unknown mechanism. Minor/Significance Unknown.

• antithrombin III

  Minor (1)acetaminophen increases effects of antithrombin III by unknown mechanism. Minor/Significance Unknown.

• apalutamide

  Monitor Closely (1)apalutamide will decrease the level or effect of acetaminophen by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.

• apomorphine

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

• arformoterol

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

• argatroban

  Minor (1)acetaminophen increases effects of argatroban by unknown mechanism. Minor/Significance Unknown.

• aripiprazole

  Monitor Closely (1)pentazocine and aripiprazole both increase sedation. Use Caution/Monitor.

• armodafinil

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

• asenapine

  Monitor Closely (1)asenapine and pentazocine both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and pentazocine both increase sedation. Use Caution/Monitor.

• aspirin

  Minor (1)aspirin, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• aspirin rectal

  Minor (1)aspirin rectal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• aspirin/citric acid/sodium bicarbonate

  Minor (1)aspirin/citric acid/sodium bicarbonate, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Possible risk of renal papillary necrosis w/chronic Tx.

• atogepant

  Monitor Closely (1)acetaminophen will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• avapritinib

  Monitor Closely (2)acetaminophen will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  avapritinib and pentazocine both increase sedation. Use Caution/Monitor.

• axitinib

  Monitor Closely (1)acetaminophen increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azelastine

  Monitor Closely (1)azelastine and pentazocine both increase sedation. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and pentazocine both increase sedation. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (1)belladonna and opium and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, belladonna and opium. 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.

• bemiparin

  Minor (1)acetaminophen increases effects of bemiparin by unknown mechanism. Minor/Significance Unknown.

• benperidol

  Monitor Closely (1)pentazocine and benperidol both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Serious - Use Alternative (3)benzhydrocodone/acetaminophen, pentazocine. 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.
  
  pentazocine decreases effects of benzhydrocodone/acetaminophen by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone (benzhydrocodone prodrug of hydrocodone) and/or precipitate withdrawal symptoms in opioid tolerant patients.
  
  benzhydrocodone/acetaminophen and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzphetamine

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

• bivalirudin

  Minor (1)acetaminophen increases effects of bivalirudin by unknown mechanism. Minor/Significance Unknown.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of pentazocine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexanolone

  Monitor Closely (1)brexanolone, pentazocine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  Monitor Closely (1)brexpiprazole and pentazocine both increase sedation. Use Caution/Monitor.

• brimonidine

  Monitor Closely (1)brimonidine and pentazocine both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of pentazocine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• brivaracetam

  Monitor Closely (1)brivaracetam and pentazocine both increase sedation. Use Caution/Monitor.

• brompheniramine

  Monitor Closely (1)brompheniramine and pentazocine both increase sedation. Use Caution/Monitor.

• bupivacaine implant

  Monitor Closely (1)acetaminophen, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

• buprenorphine

  Monitor Closely (1)buprenorphine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, pentazocine. 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

  Monitor Closely (1)buprenorphine buccal and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal, pentazocine. 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 subdermal implant

  Serious - Use Alternative (1)buprenorphine subdermal implant and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection

  Monitor Closely (1)pentazocine 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.Serious - Use Alternative (1)buprenorphine, long-acting injection and pentazocine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buspirone

  Monitor Closely (1)buspirone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• busulfan

  Monitor Closely (1)acetaminophen increases levels of busulfan by decreasing metabolism. Use Caution/Monitor. Use of acetaminophen prior to (< 72 hours) or concurrently with busulfan may result in decreased clearance of busulfan due to acetaminophen-induced decreases in glutathione levels.

• butabarbital

  Monitor Closely (1)butabarbital and pentazocine both increase sedation. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital and pentazocine both increase sedation. Use Caution/Monitor.

• butorphanol

  Monitor Closely (1)butorphanol and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)butorphanol, pentazocine. 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.

• caffeine

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

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)pentazocine, 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.

• carbamazepine

  Minor (1)carbamazepine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and pentazocine both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and pentazocine both increase sedation. Use Caution/Monitor.

• cenobamate

  Monitor Closely (1)cenobamate, pentazocine. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and pentazocine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and pentazocine both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and pentazocine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)pentazocine and chlorpromazine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and pentazocine both increase sedation. Use Caution/Monitor.

• cholestyramine

  Minor (1)cholestyramine decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• cigarette smoking

  Monitor Closely (1)cigarette smoking decreases effects of pentazocine by increasing metabolism. Use Caution/Monitor. Tobacco smoking may decrease the clinical effect of a standard pentazocine dose.

• cimetidine

  Serious - Use Alternative (1)cimetidine increases effects of pentazocine by decreasing metabolism. Avoid or Use Alternate Drug.

• cinnarizine

  Monitor Closely (1)cinnarizine and pentazocine both increase sedation. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)citalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• clemastine

  Monitor Closely (1)clemastine and pentazocine both increase sedation. Use Caution/Monitor.

• clomipramine

  Monitor Closely (2)clomipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and clomipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  Monitor Closely (1)clonazepam and pentazocine both increase sedation. Use Caution/Monitor.Minor (1)clonazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• clonidine

  Serious - Use Alternative (1)clonidine, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• clorazepate

  Monitor Closely (1)clorazepate and pentazocine both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (1)pentazocine and clozapine both increase sedation. Use Caution/Monitor.

• cocaine topical

  Monitor Closely (1)cocaine topical and pentazocine both increase serotonin levels. Use Caution/Monitor.

• codeine

  Monitor Closely (1)codeine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, codeine. 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.

• colestipol

  Minor (1)colestipol decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• cyclizine

  Monitor Closely (1)cyclizine and pentazocine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (1)cyclobenzaprine and pentazocine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and pentazocine both increase sedation. Use Caution/Monitor.

• dalteparin

  Minor (1)acetaminophen increases effects of dalteparin by unknown mechanism. Minor/Significance Unknown.

• dantrolene

  Monitor Closely (1)dantrolene and pentazocine both increase sedation. Use Caution/Monitor.

• dapsone topical

  Monitor Closely (1)acetaminophen increases toxicity of dapsone topical by altering metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia .

• daridorexant

  Monitor Closely (1)pentazocine 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.

• desflurane

  Monitor Closely (1)desflurane and pentazocine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

• desipramine

  Monitor Closely (2)desipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and desipramine both increase sedation. Use Caution/Monitor.

• desvenlafaxine

  Serious - Use Alternative (1)pentazocine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)pentazocine and deutetrabenazine both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and pentazocine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (2)pentazocine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  dexfenfluramine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and pentazocine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

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

• dextroamphetamine

  Monitor Closely (2)pentazocine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  dextroamphetamine and pentazocine both increase serotonin levels. Use Caution/Monitor.Minor (1)dextroamphetamine increases effects of pentazocine by unspecified interaction mechanism. Minor/Significance Unknown.

• dextromethorphan

  Monitor Closely (1)dextromethorphan and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextromoramide

  Monitor Closely (1)dextromoramide and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, dextromoramide. 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.

• diamorphine

  Monitor Closely (1)diamorphine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, diamorphine. 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.

• diazepam

  Monitor Closely (1)diazepam and pentazocine both increase sedation. Use Caution/Monitor.Minor (1)diazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• diazepam intranasal

  Serious - Use Alternative (1)diazepam intranasal, pentazocine. 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.

• diethylpropion

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

• difelikefalin

  Monitor Closely (1)difelikefalin and pentazocine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, difenoxin hcl. 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.

• dihydroergotamine

  Monitor Closely (1)dihydroergotamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• dihydroergotamine intranasal

  Monitor Closely (1)dihydroergotamine intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and pentazocine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (1)diphenhydramine and pentazocine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, diphenoxylate hcl. 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.

• dipipanone

  Monitor Closely (1)dipipanone and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, dipipanone. 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.

• disulfiram

  Minor (1)disulfiram will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• dobutamine

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

• dopamine

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

• dopexamine

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

• dosulepin

  Monitor Closely (1)pentazocine and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  Monitor Closely (2)doxepin and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  Monitor Closely (1)doxylamine and pentazocine both increase sedation. Use Caution/Monitor.

• droperidol

  Monitor Closely (1)pentazocine and droperidol both increase sedation. Use Caution/Monitor.

• duloxetine

  Monitor Closely (1)duloxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eletriptan

  Monitor Closely (1)eletriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• eltrombopag

  Monitor Closely (1)eltrombopag increases levels of acetaminophen by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.

• eluxadoline

  Serious - Use Alternative (1)pentazocine, 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. .

• enoxaparin

  Minor (1)acetaminophen increases effects of enoxaparin by unknown mechanism. Minor/Significance Unknown.

• ephedrine

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

• epinephrine

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

• epinephrine racemic

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

• ergotamine

  Monitor Closely (1)ergotamine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• escitalopram

  Monitor Closely (1)escitalopram and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, pentazocine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  Monitor Closely (1)estazolam and pentazocine both increase sedation. Use Caution/Monitor.

• ethanol

  Monitor Closely (1)pentazocine and ethanol both increase sedation. Use Caution/Monitor.Minor (2)ethanol will decrease the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen by decreasing metabolism. Minor/Significance Unknown.

• ethosuximide

  Minor (1)ethosuximide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• etomidate

  Monitor Closely (1)etomidate and pentazocine both increase sedation. Use Caution/Monitor.

• eucalyptus

  Minor (1)pentazocine and eucalyptus both increase sedation. Minor/Significance Unknown.

• exenatide injectable solution

  Monitor Closely (1)exenatide injectable solution will decrease the level or effect of acetaminophen by unspecified interaction mechanism. Use Caution/Monitor. To avoid potential interaction, give acetaminophen at least 1 hour before or 4 hours after exenatide injection.

• exenatide injectable suspension

  Monitor Closely (1)exenatide injectable suspension will decrease the level or effect of acetaminophen by unspecified interaction mechanism. Use Caution/Monitor. To avoid potential interaction, give acetaminophen at least 1 hour before or 4 hours after exenatide injection.

• felbamate

  Minor (1)felbamate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• fenfluramine

  Monitor Closely (2)pentazocine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  fenfluramine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• fentanyl

  Serious - Use Alternative (2)fentanyl, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• fentanyl intranasal

  Serious - Use Alternative (2)fentanyl intranasal, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• fentanyl transdermal

  Serious - Use Alternative (2)fentanyl transdermal, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl transdermal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• fentanyl transmucosal

  Serious - Use Alternative (2)fentanyl transmucosal, pentazocine. 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.
  
  pentazocine decreases effects of fentanyl transmucosal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration of mixed agonist/antagonist and partial agonist opioid analgesics may reduce fentanyl's analgesic effect and possibly precipitate withdrawal symptoms.

• finerenone

  Monitor Closely (1)acetaminophen will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

• flibanserin

  Monitor Closely (2)pentazocine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
  
  acetaminophen will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

• fluoxetine

  Monitor Closely (1)fluoxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• fluphenazine

  Monitor Closely (1)pentazocine and fluphenazine both increase sedation. Use Caution/Monitor.

• flurazepam

  Monitor Closely (1)flurazepam and pentazocine both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• fondaparinux

  Minor (1)acetaminophen increases effects of fondaparinux by unknown mechanism. Minor/Significance Unknown.

• formoterol

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

• fosphenytoin

  Minor (1)fosphenytoin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• frovatriptan

  Monitor Closely (1)frovatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• gabapentin

  Monitor Closely (1)gabapentin, pentazocine. 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

  Monitor Closely (1)gabapentin enacarbil, pentazocine. 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

  Monitor Closely (1)pentazocine and ganaxolone both increase sedation. Use Caution/Monitor.

• green tea

  Minor (1)green tea increases effects of acetaminophen by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical, due to caffeine content).

• haloperidol

  Monitor Closely (1)pentazocine and haloperidol both increase sedation. Use Caution/Monitor.

• heparin

  Minor (1)acetaminophen increases effects of heparin by unknown mechanism. Minor/Significance Unknown.

• hydrocodone

  Serious - Use Alternative (2)pentazocine decreases effects of hydrocodone by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Mixed opioid agonists/antagonists and partial opioid agonists may reduce the analgesic effect of hydrocodone and/or precipitate withdrawal symptoms in opioid tolerant patients.
  
  hydrocodone, pentazocine. 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.

• hydromorphone

  Monitor Closely (1)hydromorphone and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, hydromorphone. 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.

• hydroxyzine

  Monitor Closely (1)hydroxyzine and pentazocine both increase sedation. Use Caution/Monitor.

• iloperidone

  Monitor Closely (1)pentazocine and iloperidone both increase sedation. Use Caution/Monitor.

• imatinib

  Monitor Closely (1)imatinib decreases levels of acetaminophen by decreasing hepatic clearance. Modify Therapy/Monitor Closely. In vitro, imatinib was found to inhibit acetaminophen O-glucuronidation (Ki value of 58.5 micro-M) at therapeutic levels; avoid chronic acetaminophen therapy with imatinib; if occasional acetaminophen administered, do not exceed 1300 mg/day.

• imipramine

  Monitor Closely (2)imipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and imipramine both increase sedation. Use Caution/Monitor.

• isavuconazonium sulfate

  Monitor Closely (1)acetaminophen will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isocarboxazid

  Serious - Use Alternative (2)isocarboxazid and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  isocarboxazid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• isoniazid

  Monitor Closely (2)isoniazid and pentazocine both increase serotonin levels. Use Caution/Monitor.
  
  isoniazid will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor.Minor (1)isoniazid increases toxicity of acetaminophen by unknown mechanism. Minor/Significance Unknown.

• isoproterenol

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

• ivacaftor

  Monitor Closely (1)acetaminophen increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

• ketamine

  Monitor Closely (1)ketamine and pentazocine both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  Monitor Closely (1)pentazocine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• L-tryptophan

  Monitor Closely (1)L-tryptophan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• lacosamide

  Minor (1)lacosamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• lamotrigine

  Minor (1)lamotrigine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• lasmiditan

  Monitor Closely (1)lasmiditan, pentazocine. 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

  Monitor Closely (2)lemborexant, pentazocine. 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.
  
  acetaminophen will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

• levalbuterol

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

• levetiracetam

  Minor (1)levetiracetam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• levomilnacipran

  Monitor Closely (1)levomilnacipran and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

  Monitor Closely (2)levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will decrease the level or effect of acetaminophen by unknown mechanism. Use Caution/Monitor.
  
  acetaminophen increases levels of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by decreasing hepatic clearance. Use Caution/Monitor. Coadministration of ascorbic acid and certain combined hormonal contraceptives (CHCs) containing EE may increase plasma EE concentrations, possibly by inhibition of conjugation.

• levorphanol

  Monitor Closely (1)levorphanol and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, levorphanol. 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.

• lidocaine

  Minor (1)lidocaine increases toxicity of pentazocine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

• linezolid

  Serious - Use Alternative (2)linezolid and pentazocine 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.
  
  linezolid increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• liraglutide

  Minor (1)liraglutide decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• lisdexamfetamine

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

• lithium

  Monitor Closely (1)lithium and pentazocine both increase serotonin levels. Use Caution/Monitor.

• lixisenatide (DSC)

  Monitor Closely (1)lixisenatide (DSC) will decrease the level or effect of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. GLP1 agonists delay gastric emptying, which may affect absorption of concomitantly administered oral medications. No effects on acetaminophen Cmax and Tmax were observed when acetaminophen was administered 1 hr before lixisenatide. When administered 1 or 4 hr after lixisenatide, acetaminophen Cmax was decreased by 29% and 31% respectively and median Tmax was delayed by 2 and 1.75 hr, respectively.

• lofepramine

  Monitor Closely (2)lofepramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  Monitor Closely (1)pentazocine and lofexidine both increase sedation. Use Caution/Monitor.

• lomitapide

  Monitor Closely (1)acetaminophen increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• lonafarnib

  Serious - Use Alternative (1)acetaminophen will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• loprazolam

  Monitor Closely (1)loprazolam and pentazocine both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and pentazocine both increase sedation. Use Caution/Monitor.Minor (1)lorazepam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• lormetazepam

  Monitor Closely (1)lormetazepam and pentazocine both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)pentazocine and loxapine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (1)pentazocine and loxapine inhaled both increase sedation. Use Caution/Monitor.

• lsd

  Monitor Closely (1)lsd and pentazocine both increase serotonin levels. Use Caution/Monitor.

• lurasidone

  Monitor Closely (1)lurasidone, pentazocine. 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.

• maprotiline

  Monitor Closely (2)maprotiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and maprotiline both increase sedation. Use Caution/Monitor.

• marijuana

  Monitor Closely (1)pentazocine and marijuana both increase sedation. Use Caution/Monitor.

• melatonin

  Monitor Closely (1)pentazocine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (2)meperidine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  meperidine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)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.

• meprobamate

  Monitor Closely (1)pentazocine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

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

• metaxalone

  Monitor Closely (1)metaxalone and pentazocine both increase sedation. Use Caution/Monitor.

• methadone

  Monitor Closely (1)methadone and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, methadone. 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.

• methamphetamine

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

• methocarbamol

  Monitor Closely (1)methocarbamol and pentazocine both increase sedation. Use Caution/Monitor.

• methsuximide

  Minor (1)methsuximide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• methylene blue

  Serious - Use Alternative (1)methylene blue and pentazocine 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 pentazocine (if possible) 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.

• methylenedioxymethamphetamine

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

• metoclopramide

  Minor (1)metoclopramide increases levels of acetaminophen by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• metoclopramide intranasal

  Serious - Use Alternative (1)pentazocine, 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.

• metronidazole

  Minor (1)metronidazole will increase the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• midazolam

  Monitor Closely (1)midazolam and pentazocine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (2)midazolam intranasal, pentazocine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
  
  acetaminophen will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

• midodrine

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

• milnacipran

  Monitor Closely (1)milnacipran and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• mipomersen

  Monitor Closely (1)mipomersen, acetaminophen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• mirtazapine

  Monitor Closely (2)pentazocine and mirtazapine both increase sedation. Use Caution/Monitor.
  
  mirtazapine and pentazocine both increase serotonin levels. Use Caution/Monitor.

• modafinil

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

• morphine

  Monitor Closely (2)morphine and pentazocine both increase sedation. Use Caution/Monitor.
  
  morphine and pentazocine both increase serotonin levels. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, morphine. 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.

• motherwort

  Monitor Closely (1)pentazocine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  Monitor Closely (1)pentazocine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)pentazocine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)nalbuphine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)nalbuphine, pentazocine. 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.

• naratriptan

  Monitor Closely (1)naratriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• nefazodone

  Monitor Closely (1)nefazodone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• norepinephrine

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

• nortriptyline

  Monitor Closely (2)nortriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and nortriptyline both increase sedation. Use Caution/Monitor.

• olanzapine

  Monitor Closely (1)pentazocine and olanzapine both increase sedation. Use Caution/Monitor.

• oliceridine

  Monitor Closely (1)oliceridine, pentazocine. 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.Serious - Use Alternative (1)pentazocine, oliceridine. Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant use may reduce analgesic effect of oliceridine and/or precipitate withdrawal symptoms.

• olopatadine intranasal

  Serious - Use Alternative (1)pentazocine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• opium tincture

  Monitor Closely (1)opium tincture and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, opium tincture. 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.

• orphenadrine

  Monitor Closely (1)orphenadrine and pentazocine both increase sedation. Use Caution/Monitor.

• oxazepam

  Monitor Closely (1)oxazepam and pentazocine both increase sedation. Use Caution/Monitor.

• oxcarbazepine

  Minor (1)oxcarbazepine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• oxybutynin

  Minor (1)oxybutynin decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin topical

  Minor (1)oxybutynin topical decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• oxybutynin transdermal

  Minor (1)oxybutynin transdermal decreases levels of acetaminophen by unspecified interaction mechanism. Minor/Significance Unknown.

• oxycodone

  Monitor Closely (1)oxycodone and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, oxycodone. 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.

• oxymorphone

  Monitor Closely (1)oxymorphone and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, oxymorphone. 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.

• ozanimod

  Serious - Use Alternative (1)ozanimod and pentazocine 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.

• paliperidone

  Monitor Closely (1)pentazocine and paliperidone both increase sedation. Use Caution/Monitor.

• papaveretum

  Monitor Closely (1)papaveretum and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, papaveretum. 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.

• papaverine

  Monitor Closely (1)pentazocine and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)paroxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• pegvisomant

  Monitor Closely (1)pentazocine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and pentazocine both increase sedation. Use Caution/Monitor.

• perphenazine

  Monitor Closely (1)pentazocine and perphenazine both increase sedation. Use Caution/Monitor.

• pexidartinib

  Serious - Use Alternative (1)acetaminophen and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

• phendimetrazine

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

• phenelzine

  Serious - Use Alternative (2)phenelzine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  phenelzine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• phenindione

  Minor (1)acetaminophen increases effects of phenindione by unknown mechanism. Minor/Significance Unknown.

• phenobarbital

  Monitor Closely (1)phenobarbital and pentazocine both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• phentermine

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

• phenylephrine

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

• phenylephrine PO

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

• phenytoin

  Minor (1)phenytoin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• pholcodine

  Monitor Closely (1)pentazocine and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  Monitor Closely (1)pentazocine and pimozide both increase sedation. Use Caution/Monitor.

• pirbuterol

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

• pregabalin

  Monitor Closely (1)pregabalin, pentazocine. 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.

• pretomanid

  Serious - Use Alternative (1)acetaminophen, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

• primidone

  Monitor Closely (1)primidone and pentazocine both increase sedation. Use Caution/Monitor.Minor (1)primidone decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• procarbazine

  Serious - Use Alternative (2)procarbazine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  procarbazine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

• prochlorperazine

  Monitor Closely (1)pentazocine and prochlorperazine both increase sedation. Use Caution/Monitor.

• promethazine

  Monitor Closely (1)promethazine and pentazocine both increase sedation. Use Caution/Monitor.

• propofol

  Monitor Closely (1)propofol and pentazocine both increase sedation. Use Caution/Monitor.

• propylhexedrine

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

• protamine

  Minor (1)acetaminophen increases effects of protamine by unknown mechanism. Minor/Significance Unknown.

• protriptyline

  Monitor Closely (2)protriptyline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam and pentazocine both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)pentazocine and quetiapine both increase sedation. Use Caution/Monitor.

• ramelteon

  Monitor Closely (1)pentazocine and ramelteon both increase sedation. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. May cause additive CNS depression, drowsiness, dizziness or hypotension, so use with MAOIs should be cautious; lower initial dosages of the analgesic are recommended followed by careful titration. Avoid combination within 14 days of MAOI use.

• remimazolam

  Monitor Closely (1)remimazolam, pentazocine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration 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.

• rifabutin

  Minor (1)rifabutin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• rifampin

  Minor (1)rifampin decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• risperidone

  Monitor Closely (1)pentazocine and risperidone both increase sedation. Use Caution/Monitor.

• rizatriptan

  Monitor Closely (1)rizatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• rufinamide

  Minor (1)rufinamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• ruxolitinib

  Minor (1)acetaminophen will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  Minor (1)acetaminophen will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage

  Minor (1)pentazocine and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

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

• SAMe

  Monitor Closely (1)pentazocine and SAMe both increase serotonin levels. Use Caution/Monitor.

• scullcap

  Monitor Closely (1)pentazocine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital and pentazocine both increase sedation. Use Caution/Monitor.

• selegiline

  Monitor Closely (1)selegiline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.

• selegiline transdermal

  Monitor Closely (1)selegiline transdermal and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)selegiline transdermal increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• selinexor

  Serious - Use Alternative (1)selinexor, pentazocine. 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

  Monitor Closely (1)sertraline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• sevoflurane

  Monitor Closely (1)sevoflurane and pentazocine both increase sedation. Use Caution/Monitor.

• shepherd's purse

  Monitor Closely (1)pentazocine and shepherd's purse both increase sedation. Use Caution/Monitor.

• sodium oxybate

  Serious - Use Alternative (1)pentazocine, 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

  Monitor Closely (1)pentazocine and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.

• stiripentol

  Monitor Closely (1)stiripentol, pentazocine. 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

  Monitor Closely (1)pentazocine and sufentanil both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, sufentanil. 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.

• sufentanil SL

  Serious - Use Alternative (1)sufentanil SL, pentazocine. 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.

• sumatriptan

  Monitor Closely (1)sumatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.

• suvorexant

  Monitor Closely (1)suvorexant and pentazocine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tapentadol

  Monitor Closely (1)pentazocine and tapentadol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, tapentadol. 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.

• tazemetostat

  Monitor Closely (1)acetaminophen will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• temazepam

  Monitor Closely (1)temazepam and pentazocine both increase sedation. Use Caution/Monitor.

• terbutaline

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

• tetracaine

  Monitor Closely (1)tetracaine, acetaminophen. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

• thioridazine

  Monitor Closely (1)pentazocine and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  Monitor Closely (1)pentazocine and thiothixene both increase sedation. Use Caution/Monitor.

• tiagabine

  Minor (1)tiagabine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• tinidazole

  Monitor Closely (1)acetaminophen will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• topiramate

  Monitor Closely (1)pentazocine and topiramate both increase sedation. Modify Therapy/Monitor Closely.Minor (1)topiramate decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• tramadol

  Monitor Closely (2)pentazocine and tramadol both increase sedation. Use Caution/Monitor.
  
  pentazocine and tramadol both increase serotonin levels. Use Caution/Monitor.Serious - Use Alternative (2)tramadol, pentazocine. 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.
  
  pentazocine, tramadol. 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.

• tranylcypromine

  Serious - Use Alternative (2)tranylcypromine and pentazocine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  tranylcypromine increases toxicity of pentazocine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• trazodone

  Monitor Closely (2)trazodone and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  Monitor Closely (1)triazolam and pentazocine both increase sedation. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos and pentazocine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)pentazocine and trifluoperazine both increase sedation. Use Caution/Monitor.

• trimipramine

  Monitor Closely (2)trimipramine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  pentazocine and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  Monitor Closely (1)triprolidine and pentazocine both increase sedation. Use Caution/Monitor.

• valerian

  Serious - Use Alternative (1)valerian and pentazocine both increase sedation. Avoid or Use Alternate Drug.

• valproic acid

  Minor (1)valproic acid decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

• venlafaxine

  Monitor Closely (1)venlafaxine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• warfarin

  Monitor Closely (1)acetaminophen increases effects of warfarin by anticoagulation. Use Caution/Monitor.

• xylometazoline

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

• yohimbine

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

• ziconotide

  Monitor Closely (1)pentazocine and ziconotide both increase sedation. Use Caution/Monitor.Minor (1)ziconotide, pentazocine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

• ziprasidone

  Monitor Closely (1)pentazocine and ziprasidone both increase sedation. Use Caution/Monitor.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.

• zonisamide

  Minor (1)zonisamide decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism increase levels of hepatotoxic metabolites.

• zotepine

  Monitor Closely (1)pentazocine and zotepine both increase sedation. Use Caution/Monitor.