opioid
11 interactions related to opioid
tramadol + st. john's wort
Tramadol inhibits serotonin and norepinephrine reuptake, and St. John's Wort increases central serotonergic activity, so combining them can add together and raise the risk of serotonin syndrome. St. John's Wort also induces CYP3A4 and CYP2B6, enzymes involved in tramadol metabolism, which may lower levels of tramadol's active M1 metabolite and weaken pain relief.
oxycodone + st. john's wort
St. John's Wort strongly induces CYP3A4, the main enzyme that clears oxycodone. In a controlled trial, taking St. John's Wort for about two weeks markedly lowered oxycodone blood levels and weakened its pain-relieving effect, so combining the two can leave pain poorly controlled.
grapefruit + methadone
Grapefruit inhibits intestinal CYP3A4, an enzyme that partly clears methadone, which can raise methadone blood levels. The effect is usually modest in stable patients but can become clinically significant with sustained heavy intake.
grapefruit + oxycodone
Oxycodone is broken down mainly by the intestinal enzyme CYP3A4. Grapefruit juice blocks that enzyme, so more active oxycodone reaches the bloodstream and stays there longer, and metabolism shifts toward the more potent metabolite oxymorphone. A controlled study in healthy volunteers confirmed grapefruit juice meaningfully raises oxycodone exposure, increasing the risk of excessive sedation and slowed breathing.
alcohol + pregabalin
Pregabalin and alcohol are both central nervous system depressants. Taken together their sedative effects add up, increasing drowsiness, dizziness, and impaired coordination, and at the serious end can cause life-threatening respiratory depression — a risk highlighted by FDA and MHRA safety warnings.
alcohol + tramadol
Tramadol combined with alcohol produces additive central nervous system and respiratory depression, and the combination lowers the seizure threshold, increasing the risk of convulsions, serotonin-related reactions, and life-threatening overdose. Tramadol's serotonergic and noradrenergic activity makes this pairing more hazardous than alcohol with a typical opioid.
alcohol + codeine
Codeine and alcohol are both central nervous system depressants. Taken together they add up, slowing breathing and deepening sedation, with the risk of dangerous or fatal respiratory depression. The danger is amplified for people who convert codeine to morphine unusually fast (CYP2D6 ultra-rapid metabolizers), who can experience strong opioid effects from ordinary doses.
alcohol + hydrocodone
Hydrocodone and alcohol are both central nervous system depressants. Taken together they cause additive depression of the brainstem breathing centers, which can lead to profound sedation, dangerously slowed or stopped breathing, coma, and death even at otherwise-tolerated opioid doses. Some extended-release hydrocodone formulations can also "dose dump" when combined with alcohol, releasing the dose prematurely. Hydrocodone-acetaminophen products add a separate alcohol-related liver-injury risk.
tramadol + 5-htp
Tramadol blocks the reuptake of serotonin, and 5-HTP is a direct precursor that raises serotonin production in the brain. Stacking the two can push serotonin activity too high and trigger serotonin syndrome, a potentially life-threatening reaction.
alcohol + gabapentin
Gabapentin and alcohol are both central nervous system depressants. Combining them increases drowsiness, dizziness, impaired coordination, and the risk of serious, potentially life-threatening respiratory depression, especially in older adults and people with lung disease, sleep apnea, kidney impairment, or who take opioids or other sedatives.
alcohol + oxycodone
Alcohol and oxycodone are both central nervous system depressants. Taken together they add up, slowing breathing and deepening sedation to a degree that can be life-threatening even when each amount would be tolerated alone. The FDA carries its strongest (boxed) warning on this combination, and national mortality data show alcohol is involved in a meaningful share of opioid overdose deaths.