Template:DangerousInteractions/Opioids: Difference between revisions

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*'''[[DangerousInteraction::Tramadol]]''' - Increased risk of seizures. Tramadol itself is known to induce seizures and it may have additive effects on seizure threshold with other opioids. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.

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*'''[[DangerousInteraction::Grapefruit]]''' - While grapefruit is not psychoactive, it may affect the metabolism of certain opioids. ~~Tramadol,~~ oxycodone, and fentanyl ~~are all~~ primarily metabolized by the enzyme CYP3A4, which is potently inhibited by grapefruit juice<ref name="Ershad2020">{{cite journal | vauthors=((Ershad, M.)), ((Cruz, M. D.)), ((Mostafa, A.)), ((Mckeever, R.)), ((Vearrier, D.)), ((Greenberg, M. I.)) | journal=Journal of Addiction Medicine | title=Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance | volume=14 | issue=2 | pages=172–174 | date= March 2020 | url=https://journals.lww.com/10.1097/ADM.0000000000000535 | issn=1932-0620 | doi=10.1097/ADM.0000000000000535}}</ref>. This may cause the drug to take longer to clear from the body. it may increase toxicity with repeated doses. Methadone may also be affected<ref name="Ershad2020"/>. Codeine and ~~hydrocodone~~ are metabolized by CYP2D6. People who are on medicines that inhibit CYP2D6, or that lack the enzyme due to a genetic mutation will not respond to codeine as it can not be metabolized into its active product: morphine.

*'''[[DangerousInteraction::Grapefruit]]''' - While grapefruit is not psychoactive, it may affect the metabolism of certain opioids. Certain opioids such as oxycodone and fentanyl primarily metabolized by the enzyme CYP3A4, which is potently inhibited by grapefruit juice<ref name="Ershad2020">{{cite journal | vauthors=((Ershad, M.)), ((Cruz, M. D.)), ((Mostafa, A.)), ((Mckeever, R.)), ((Vearrier, D.)), ((Greenberg, M. I.)) | journal=Journal of Addiction Medicine | title=Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance | volume=14 | issue=2 | pages=172–174 | date= March 2020 | url=https://journals.lww.com/10.1097/ADM.0000000000000535 | issn=1932-0620 | doi=10.1097/ADM.0000000000000535}}</ref>. This may cause the drug to take longer to clear from the body. it may increase toxicity with repeated doses. Methadone may also be affected<ref name="Ershad2020"/>. Codeine, hydrocodone, and Tramadol are metabolized by CYP2D6. People who are on medicines that inhibit CYP2D6, or that lack the enzyme due to a genetic mutation will not respond to codeine as it can not be metabolized into its active product: morphine.

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 *'''[[DangerousInteraction::Tramadol]]''' - Increased risk of seizures. Tramadol itself is known to induce seizures and it may have additive effects on seizure threshold with other opioids. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present.
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-*'''[[DangerousInteraction::Grapefruit]]''' - While grapefruit is not psychoactive, it may affect the metabolism of certain opioids. Tramadol, oxycodone, and fentanyl are all primarily metabolized by the enzyme CYP3A4, which is potently inhibited by grapefruit juice<ref name="Ershad2020">{{cite journal | vauthors=((Ershad, M.)), ((Cruz, M. D.)), ((Mostafa, A.)), ((Mckeever, R.)), ((Vearrier, D.)), ((Greenberg, M. I.)) | journal=Journal of Addiction Medicine | title=Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance | volume=14 | issue=2 | pages=172–174 | date= March 2020 | url=https://journals.lww.com/10.1097/ADM.0000000000000535 | issn=1932-0620 | doi=10.1097/ADM.0000000000000535}}</ref>. This may cause the drug to take longer to clear from the body. it may increase toxicity with repeated doses. Methadone may also be affected<ref name="Ershad2020"/>.  Codeine and hydrocodone are metabolized by CYP2D6. People who are on medicines that inhibit CYP2D6, or that lack the enzyme due to a genetic mutation will not respond to codeine as it can not be metabolized into its active product: morphine.
+*'''[[DangerousInteraction::Grapefruit]]''' - While grapefruit is not psychoactive, it may affect the metabolism of certain opioids. Certain opioids such as oxycodone and fentanyl primarily metabolized by the enzyme CYP3A4, which is potently inhibited by grapefruit juice<ref name="Ershad2020">{{cite journal | vauthors=((Ershad, M.)), ((Cruz, M. D.)), ((Mostafa, A.)), ((Mckeever, R.)), ((Vearrier, D.)), ((Greenberg, M. I.)) | journal=Journal of Addiction Medicine | title=Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance | volume=14 | issue=2 | pages=172–174 | date= March 2020 | url=https://journals.lww.com/10.1097/ADM.0000000000000535 | issn=1932-0620 | doi=10.1097/ADM.0000000000000535}}</ref>. This may cause the drug to take longer to clear from the body. it may increase toxicity with repeated doses. Methadone may also be affected<ref name="Ershad2020"/>.  Codeine, hydrocodone, and Tramadol are metabolized by CYP2D6. People who are on medicines that inhibit CYP2D6, or that lack the enzyme due to a genetic mutation will not respond to codeine as it can not be metabolized into its active product: morphine.