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 raises the risk of serotonin syndrome. St. John's Wort also induces CYP3A4 and CYP2B6, which can reduce tramadol's active M1 metabolite and weaken analgesia.
oxycodone + st. john's wort
St. John's Wort strongly induces CYP3A4, the main enzyme that metabolizes oxycodone. In a controlled crossover trial, St. John's Wort cut oral oxycodone plasma exposure (AUC) by roughly 50% and significantly reduced its analgesic effect.
grapefruit + methadone
Methadone is partially metabolized by CYP3A4 (and CYP2B6). Grapefruit juice inhibits intestinal CYP3A4 and can raise methadone plasma concentrations, with case reports of opioid toxicity after sustained grapefruit juice intake. Higher methadone levels also increase the risk of QT prolongation and torsades de pointes.
grapefruit + oxycodone
Oxycodone undergoes CYP3A4-mediated metabolism to noroxycodone. A controlled crossover study in healthy volunteers showed grapefruit juice increased oxycodone AUC 1.7-fold, peak concentration 1.5-fold, and half-life 1.2-fold, while reducing formation of inactive noroxycodone, raising the risk of sedation and respiratory depression.
alcohol + pregabalin
Pregabalin (Lyrica) and alcohol are both central nervous system depressants with additive effects on sedation, coordination, and respiratory drive. The FDA's 2019 Drug Safety Communication warned that pregabalin can cause life-threatening respiratory depression when combined with CNS depressants such as alcohol, particularly with opioids or in patients with lung disease.
alcohol + tramadol
Tramadol combined with alcohol produces additive CNS and respiratory depression, and the combination significantly lowers the seizure threshold, increasing the risk of convulsions, serotonin syndrome, and overdose death. Tramadol has unique serotonergic and noradrenergic activity that compounds alcohol's effects beyond what occurs with pure opioids.
alcohol + codeine
Codeine combined with alcohol produces additive CNS and respiratory depression, with risk of fatal overdose particularly elevated in CYP2D6 ultra-rapid metabolizers who convert codeine to morphine rapidly. The combination also increases sedation, impaired judgment, and the risk of accidents.
alcohol + hydrocodone
Hydrocodone combined with alcohol produces dangerous additive CNS and respiratory depression with high risk of fatal overdose. Extended-release hydrocodone formulations can experience dose dumping when combined with alcohol, releasing the entire dose at once and causing potentially lethal blood concentrations.
tramadol + 5-htp
Tramadol inhibits serotonin reuptake, and 5-HTP is a direct precursor to serotonin that increases central serotonin synthesis. Combining them can cause serotonin syndrome, a potentially life-threatening reaction.
alcohol + gabapentin
Gabapentin and alcohol are both central nervous system depressants. The FDA issued a 2019 Drug Safety Communication warning that gabapentin can cause serious, potentially fatal respiratory depression when combined with CNS depressants including alcohol, particularly in older adults and patients with respiratory disease.
alcohol + oxycodone
Combining alcohol with oxycodone causes additive central nervous system and respiratory depression, dramatically increasing the risk of fatal overdose, sedation, and impaired breathing. Alcohol can also accelerate the release of oxycodone from extended-release formulations, causing dangerous spikes in blood levels.