Table 4.
Opioid | Analgesic effects of DDIs
|
||
---|---|---|---|
Induction of CYP3A4 | Inhibition of CYP3A4 | Inhibition of CYP2D6 | |
Morphinea | No likely clinical consequences | No likely clinical consequences | N/A |
Hydrocodone | Potential increase in opioid effects; patient monitoring recommended | Potential decrease in opioid effects; patient monitoring recommended | N/A |
Oxycodone | Decrease in opioid effects; avoid combination when possible | Increase in opioid effects (black box warning); avoid combination | Potential decrease in opioid effects |
Oxymorphonea | N/A | N/A | N/A |
Buprenorphine | Decrease in opioid effects | Increase in opioid effects | N/A |
Levorphanola | N/A | N/A | N/A |
Fentanyl | Decrease in opioid effects; avoid combination when possible | Increase in opioid effects (black box warning); avoid combination | N/A |
Methadone | Decrease in opioid effects; avoid combination | Increase in opioid effects; avoid combination when possible | Increase in opioid effects; avoid combination |
Notes: Drugs metabolized primarily by UGT2B7 (Phase II) and not likely to be associated with significant DDIs caused by alterations to CYP3A4 and CYP2D6. For more information on Buprenorphine see McCance-Katz et al.146 Copyright © 2011. Adapted from The American Journal of Managed Care. Overholser BR, Foster DR. Opioid pharmacokinetic drug-drug interactions. Am J Manag Care. 2011;17(suppl 11):S276–S287.147
Abbreviations: CYP, cytochrome P450; DDIs, drug–drug interactions; N/A, not applicable.