title: Drug interactions - Neonatal Intensive Care Drug Manual
text: Drug interactions
  Concurrent administration with erythromycin promotes accumulation.
  Xanthines may decrease the anaesthetic/sedative effect of benzodiazepines. Care needs to be taken with adding or withdrawing caffeine or aminophylline.
  Adverse reactions
  Hypotension and reduced cardiac output, particularly when used in combination with fentanyl.
  Respiratory depression and apnoea.
  Hypersalivation.
  Nasal discomfort (with intranasal route).
  Seizure-like myoclonus (more common in premature neonates receiving via intravenous route).
  Compatibility
  Fluids: Glucose 5%, glucose 10%, sodium chloride 0.9%.
  Y-site: Amino acid solutions. Abciximab, amikacin, amiodarone, anidulafungin, atracurium, bivalirudin, calcium gluconate, caspofungin, cefotaxime cefazolin, ciprofloxacin, cisatracurium, clindamycin, digoxin, dopamine, doripenem, eptifibatide, erythromycin, esmolol, fentanyl, fluconazole, gentamicin, glyceryl trinitrate, haloperidol lactate, hydromorphone, labetalol, linezolid, methadone, methylprednisolone, metronidazole, milrinone, morphine sulfate, noradrenaline (norepinephrine), palonosetron, pancuronium, potassium chloride, ranitidine, remifentanil, sodium nitroprusside, tirofiban, tobramycin, vancomycin, vecuronium.
  Incompatibility
  Fluids: No information.
  Y-site: Fat emulsion. Aciclovir, albumin, aminophylline, amoxicillin, ampicillin, azathioprine, azithromycin, cefepime, ceftazidime, chloramphenicol, clonidine, dexamethasone, ertapenem, esomeprazole, flucloxacillin, foscarnet, furosemide (frusemide), ganciclovir, hydrocortisone sodium succinate, imipenem-cilastatin, indomethacin, omeprazole, phenobarbital (phenobarbitone), piperacillin-tazobactam (EDTA-free), potassium acetate, sodium bicarbonate, thiopental (thiopentone), tramadol, trimethoprim-sulfamethoxazole.
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