Template:DangerousInteractions/Opioids: Difference between revisions

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*'''[[UncertainInteraction::PCP]]''' - PCP can reduce opioid tolerance, increasing the risk of overdose.

*'''[[DangerousInteraction::Tramadol]]''' - Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present

*'''[[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=":0">[https://journals.lww.com/journaladdictionmedicine/Citation/2020/04000/Opioid_Toxidrome_Following_Grapefruit_Juice.14.aspx]</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=":0" />. 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 it's active product, morphine.

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 *'''[[UncertainInteraction::PCP]]''' - PCP can reduce opioid tolerance, increasing the risk of overdose.
 *'''[[DangerousInteraction::Tramadol]]''' - Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. Central nervous system- and/or respiratory-depressant effects may be additively or synergistically present
+*'''[[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=":0">[https://journals.lww.com/journaladdictionmedicine/Citation/2020/04000/Opioid_Toxidrome_Following_Grapefruit_Juice.14.aspx]</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=":0" />.  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 it's active product, morphine.