Drug General Information (ID: DDI1IYX3AL)
Drug Name			Buspirone		Drug Info		Remifentanil		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antianxiety Agents				Anxiolytics/Sedatives/Hypnotics
Structure

Mechanism of Buspirone-Remifentanil Interaction (Severity Level: Major)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Buspirone				Remifentanil
Mechanism 1		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Buspirone and Remifentanil
Additive serotonergic effects Click to Show/Hide Mechanism Graph
Drug Name		Buspirone				Remifentanil
Mechanism 2		Serotonergic effects				Serotonergic effects
Key Mechanism Factor 2
		Factor Name		Serotonergic effects
		Factor Description		Serotonergic drugs include a variety of drugs that enhance or mimic the effects of the neurotransmitter serotonin. Excessive serotonergic activation may lead to a condition known as serotonin syndrome, in which high levels of serotonin in the brain cause the following symptoms: changes in blood pressure, coma, fever, increased heart rate, hallucinations, nausea, and seizures.
Mechanism Description		Additive serotonergic effects by the combination of Buspirone and Remifentanil

Recommended Action
Management		The use of opioids in conjunction with other CNS depressants should generally be avoided unless alternative treatment options are inadequate. If coadministration is necessary, the dosage and duration of each drug should be limited to the minimum required to achieve desired clinical effect. Patients should be monitored closely for signs and symptoms of respiratory depression and sedation, and advised to avoid driving or operating hazardous machinery until they know how these medications affect them. In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

References
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