Selected Opioids/Selected Strong CYP3A4 Inducers Interactions
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.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
When these two medicines are taken together, your body may process your pain medicine more quickly.
What might happen:
Your blood levels of your pain medicine may decrease and it may not work as well. You may experience drug withdrawal symptoms.
What you should do about this interaction:
Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. If your medicine does not seem to be working as well, contact your healthcare professionals. If you experience nausea, vomiting, stomach pain, diarrhea, irritability, sleep disturbances, or other symptoms, contact your healthcare professionals. Your doctor may want to adjust the dose of your medicine.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.
- 1.McCance-Katz EF, Moody DE, Prathikanti S, Friedland G, Rainey PM. Rifampin, but not rifabutin, may produce opiate withdrawal in buprenorphine-maintained patients. Drug Alcohol Depend 2011 Nov 1; 118(2-3):326-34.
- 2.Demerol (meperidine hydrochloride) US prescribing information. Validus Pharmaceuticals LLC. October, 2019.
- 3.Pond SM, Kretschzmar KM. Effect of phenytoin on meperidine clearance and normeperidine formation. Clin Pharmacol Ther 1981 Nov;30(5):680-6.
- 4.Stambaugh JE Jr, Wainer IW, Schwartz I. The effect of phenobarbital on the metabolism of meperidine in normal volunteers. J Clin Pharmacol 1978 Oct; 18(10):482-90.
- 5.Fromm MF, Eckhardt K, Li S, Schanzle G, Hofmann U, Mikus G, Eichelbaum M. Loss of analgesic effect of morphine due to coadministration of rifampin. Pain 1997 Aug;72(1-2):261-7.
- 6.Dsuvia (sufentanil) sublingual tablet US prescribing information. AcelRx Pharmaceuticals, Inc. October, 2019.
- 7.Nieminen TH, Hagelberg NM, Saari TI, Neuvonen M, Laine K, Neuvonen PJ, Olkkola KT. St John's wort greatly reduces the concentrations of oral oxycodone. Eur J Pain 2010 Sep;14(8):854-9.
- 8.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.
- 9.Kharasch ED, Russell M, Mautz D, Thummel KE, Kunze KL, Bowdle A, Cox K. The role of cytochrome P450 3A4 in alfentanil clearance. Implications for interindividual variability in disposition and perioperative drug interactions. Anesthesiology 1997 Jul;87(1):36-50.
- 10.Tempelhoff R, Modica PA, Spitznagel EL Jr. Anticonvulsant therapy increases fentanyl requirements during anaesthesia for craniotomy. Can J Anaesth 1990 Apr;37(3):327-32.
- 11.Pon D, Hwang J, Lo T, Zyl CV. Decreased responsiveness to oxycodone: A case of a pharmacokinetic drug interaction?. J Opioid Manag 2015 Jul-Aug; 11(4):357-61.
- 12.Lee HK, Lewis LD, Tsongalis GJ, McMullin M, Schur BC, Wong SH, Yeo KT. Negative urine opioid screening caused by rifampin-mediated induction of oxycodone hepatic metabolism. Clin Chim Acta 2006 May;367(1-2):196-200.
- 13.Morii H, Chiba M, Konishi H, Endo Y, Yamaji A. Failure of pain control using transdermal fentanyl during rifampicin treatment. J Pain Symptom Manage 2007 Jan;33(1):5-6.
- 14.Takane H, Nosaka A, Wakushima H, Hosokawa K, Ieiri I. Rifampin reduces the analgesic effect of transdermal fentanyl. Ann Pharmacother 2005 Dec; 39(12):2139-40.
- 15.Sublocade (buprenorphine extended release injection). Indivior Inc. October, 2019.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.