Fentanyl; Oxycodone/Selected Macrolide Antibiotics (mono deleted 03/16/2012)
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Your antibiotic may slow down how quickly your liver processes your pain medicine.
What might happen:
The amount of pain medicine in your blood may increase and you may become more drowsy than normal.
What you should do about this interaction:
Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to adjust the dose of your medicine.If you feel more sleepy or tired than normal, contact your healthcare professional as soon as possible.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
References:
1.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. July, 2012.
2.OxyContin (oxycodone hydrochloride) US prescribing information. Perdue Pharma L.P. July, 2012.
3.Bartkowski RR, Goldberg ME, Larijani GE, Boerner T. Inhibition of alfentanil metabolism by erythromycin. Clin Pharmacol Ther 1989 Jul; 46(1):99-102.
4.Kharasch ED, Walker A, Hoffer C, Sheffels P. Intravenous and oral alfentanil as in vivo probes for hepatic and first-pass cytochrome P450 3A activity: noninvasive assessment by use of pupillary miosis. Clin Pharmacol Ther 2004 Nov;76(5):452-66.
5.Kharasch ED, Whittington D, Hoffer C. Influence of hepatic and intestinal cytochrome P4503A activity on the acute disposition and effects of oral transmucosal fentanyl citrate. Anesthesiology 2004 Sep;101(3):729-37.
6.Gronlund J, Saari T, Hagelberg N, Martikainen IK, Neuvonen PJ, Olkkola KT, Laine K. Effect of telithromycin on the pharmacokinetics and pharmacodynamics of oral oxycodone. J Clin Pharmacol 2010 Jan;50(1):101-8.
7.Bartkowski RR, McDonnell TE. Prolonged alfentanil effect following erythromycin administration. Anesthesiology 1990 Sep;73(3):566-8.
8.Horton R, Barber C. Opioid-induced respiratory depression resulting from transdermal fentanyl-clarithromycin drug interaction in a patient with advanced COPD. J Pain Symptom Manage 2009 Jun;37(6):e2-5.
9.Feierman DE, Lasker JM. Metabolism of fentanyl, a synthetic opioid analgesic, by human liver microsomes. Role of CYP3A4. Drug Metab Dispos 1996 Sep;24(9):932-9.
10.Klees TM, Sheffels P, Dale O, Kharasch ED. Metabolism of alfentanil by cytochrome p4503a (cyp3a) enzymes. Drug Metab Dispos 2005 Mar; 33(3):303-11.
11.Tateishi T, Krivoruk Y, Ueng YF, Wood AJ, Guengerich FP, Wood M. Identification of human liver cytochrome P-450 3A4 as the enzyme responsible for fentanyl and sufentanil N-dealkylation. Anesth Analg 1996 Jan;82(1):167-72.
