Opioid Drug Interactions

Question 1

Opioid Absorption

Answer 1

• Well absorbed from SQ, IM, transdermal, and mucosal surfaces
• Most have extensive 1st pass metabolism
• Low bioavailability overall

Question 2

Absorption interactions

Answer 2

-delay gastric emptying & absorption of many orally administered drugs (especially platelet inhibitors)

Question 3

CYP3A4 Substrates

Answer 3

• Oxycodone (major)
• Hydrocodone (major)
• fentanyl (major)
• buprenorphine
• tramadol (major)

***All of these are contraindicated with Clarithromycin

Question 4

CYP2D6 Substrates (Major)

Answer 4

• Codeine (major)
• Tramadol (major)
• Oxycodone (minor)
• Hydrocodone (minor)
• Potent CYP2D6 inhibitors will prevent these drugs from being converted
• Ultra-rapid metabolizers may have issues with OD

Question 5

Opioids with essentially no CYP interaction

Answer 5

• Hydromorphone
• oxymorphone
• Morphine

**more predictable in patients with CYP2D6 polymorphisms

Question 6

Mu Receptor

Answer 6

-analgesia, euphoria, respiratory depression, physical dependence properties

Question 7

Opioid additive interactions

Answer 7

• Additive analgesia with APAP/NSAIDs –> GOOD!

- Increased sedation with other sedatives/hypnotics –> BAD!

Question 8

All Opioids have a black box warning regarding what class of drugs?

Answer 8

Benzos

Question 9

Which drug class is contraindicated with or within 14 days of using an opioid?

Answer 9

MAOI

**All products contraindicated

Question 10

What two opioids put patients at risk for serotonin syndrome when combined with other serotonergic drugs?

Answer 10

• Tramadol

- Fentanyl

Question 11

What is a common result of mixing opioids and anticholinergic drugs?

Answer 11

Constipation

Question 12

Which two opioids increase the risk of seizures if combined with bupropion, SSRI/SNRI, TCA, or antipsychotics?

Answer 12

• Tramadol

- Tapentadol