TABLE 3.
Clinical suggestions to manage opioid drug-drug interactions
| Object Drug | Interaction Type | Changes in object drug pharmacokinetics/pharmacodynamics | Clinical suggestion |
|---|---|---|---|
| Hydrocodone | Inhibition CYP3A4 |
Decreased norhydrocodone formation with increases in hydrocodone plasma concentrations; may lead to increases in pharmacodynamic effects (analgesia, respiratory depression) | Decrease the dosage/ frequency of hydrocodone intake; remove CYP3A4 inhibitor from the regimen if possible* |
| CYP2D6 | Decreased hydromorphone formation; may lead to decreases in pharmacodynamic effect (analgesia) | Review patients genotype for CYP2D6 – alterations in dosing may be necessary for UM individuals* | |
| Induction CYP3A4 |
Increased norhydrocodone metabolite formation and overall clearance of hydrocodone; may lead to decreases in pharmacodynamic efficacy (analgesia) | Increase the dosage/frequency of hydrocodone intake; remove CYP3A4 inducer from regimen if possible* | |
| Oxycodone | Inhibition CYP3A4 |
Decreased noroxycodone formation with increases in oxycodone and oxymorphone; may lead to increases in pharmacodynamic effects (analgesia, respiratory depression) | Decrease the dosage/frequency of oxymorphone intake; remove CYP3A4 inhibitor from regimen if possible* |
| CYP2D6 | Decreased oxymorphone formation with an increase in noroxycodone and oxycodone; may lead to decrease in pharmacodynamic effect (analgesia) | Review patient’s genotype for CYP2D6 – alterations in dosing may be necessary for UM and PM individuals* | |
| Induction CYP3A4 |
Increased noroxycodone metabolite formation and overall clearance of oxycodone; may lead to decrease in pharmacodynamic efficacy (analgesia) | Increase the dosage/frequency of oxymorphone; remove CYP3A4 inducer from regimen if possible* | |
| Morphine | Inhibition UGT2B7 |
Decreased glucuronide metabolites and increases in morphine; may lead to increase in pharmacodynamic effect (analgesia) | Decrease the dosage/frequency of morphine; remove UGT2B7 inhibitor from regimen if possible* |
*In all cases, patients should be closely monitored, and removal of the precipitant drug may necessitate additional therapy modifications.