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Transdermal fentanyl combined with nonsteroidal anti-inflammatory drugs for analgesia in horses. Thomasy SM(1), Slovis N, Maxwell LK, Kollias-Baker C. Author information: (1)K.L.ransdermal fentanyl combined with nonsteroidal anti-inflammatory drugs for analgesia in horses. Thomasy SM(1), Slovis N, Maxwell LK, Kollias-Baker C. Author information: (1)K.L.
We present a complex medical patient who suffered an exacerbation of delirium when diltiazem was added to his treatment regimen that included fentanyl. Diltiazem, an inhibitor of CYP3A4, resulted in fentanyl toxicity because fentanyl is metabolized by CYP3A4. Fentanyl contains a boxed warning for concomitant use with 3A4 inhibitors . Pharmacy programs such as Lexi-comp and MicroMedics are available to identify such drug-drug interactions, which are entirely preventable.