Selected Opioid Analgesics/Cimetidine 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:
Cimetidine may slow down how quickly your body processes some pain medicines.
What might happen:
The amount of pain medicine in your blood may increase, which may increase your risk of nausea, vomiting, constipation, lightheadedness, dizziness, and excessive drowsiness. Your pain medicine may cause very serious side effects including shortness of breath or difficulty breathing.
What you should do about this interaction:
Let your healthcare professionals (e.g. doctor or pharmacist) know right away that you are taking these medicines together. If you have any signs of excessive drowsiness or have trouble breathing, contact your doctor right away. Your doctor may want to adjust the dose of your pain 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.Tagamet (cimetidine) US prescribing information. GlaxoSmithKline December, 2005.
- 2.Soleimanpour H, Safari S, Shahsavari Nia K, Sanaie S, Alavian SM. Opioid Drugs in Patients With Liver Disease: A Systematic Review. Hepat Mon 2016 Apr;16(4):e32636.
- 3.MacKenzie M, Zed PJ, Ensom MH. Opioid Pharmacokinetics-Pharmacodynamics: Clinical Implications in Acute Pain Management in Trauma. Ann Pharmacother 2016 Mar;50(3):209-18.
- 4.Kotlinska-Lemieszek A, Klepstad P, Haugen DF. Clinically significant drug-drug interactions involving opioid analgesics used for pain treatment in patients with cancer: a systematic review. Drug Des Devel Ther 2015; 9:5255-67.
- 5.Stadol (butorphanol tartrate) US prescribing information. Bristol-Myers Squibb April, 2002.
- 6.Zohydro ER (hydrocodone bitarate) US prescribing information. Zogenix Inc. August, 2014.
- 7.Demerol (meperidine hydrochloride) US prescribing information. Sanofi-Synthelabo, Inc. August, 2017.
- 8.Dolophine (methadone hydrochloride) US prescribing information. Wast-Ward Pharmaceuticals Corp. February 1, 2018.
- 9.Nubain (nalbuphine hydrochloride) US prescribing information. Endo Pharmaceuticals Inc. December, 2016.
- 10.OxyContin (oxycodone hydrochloride) US prescribing information. Perdue Pharma L.P. September, 2018.
- 11.Opana ER (oxymorphone hydrochloride) US prescribing information. Endo Pharmaceuticals, Inc. September, 2018.
- 12.Dilaudid (hydromorphone) US prescribing information. Purdue Pharm Prods September, 2018.
- 13.Apadaz (benzhydrocodone and acetaminophen) US prescribing information. KemPharm, Inc.. February, 2018.
- 14.Actiq (fentanyl citrate) Australian prescribing information. Orphan Australia Pty Ltd. November 2, 2002.
- 15.Duragesic (fentanyl) US prescribing information. Janssen Pharmaceuticals, Inc. August, 2014.
- 16.This information is based on or an extract from the UW Metabolism and Transport Drug Interaction Database (DIDB) Platform, Copyright University of Washington 1999-2014..
- 17.Moody DE, Liu F, Fang WB. In vitro inhibition of methadone and oxycodone cytochrome P450-dependent metabolism: reversible inhibition by H2-receptor agonists and proton-pump inhibitors. J Anal Toxicol 2013 Oct; 37(8):476-85.
- 18.Kharasch ED, Vangveravong S, Buck N, London A, Kim T, Blood J, Mach RH. Concurrent assessment of hepatic and intestinal cytochrome P450 3A activities using deuterated alfentanil. Clin Pharmacol Ther 2011 Apr; 89(4):562-70.
- 19.Ziesenitz VC, Konig SK, Mahlke NS, Skopp G, Haefeli WE, Mikus G. Pharmacokinetic interaction of intravenous fentanyl with ketoconazole. J Clin Pharmacol 2015 Jun;55(6):708-17.
- 20.Hutchinson MR, Menelaou A, Foster DJ, Coller JK, Somogyi AA. CYP2D6 and CYP3A4 involvement in the primary oxidative metabolism of hydrocodone by human liver microsomes. Br J Clin Pharmacol 2004 Mar;57(3):287-97.
- 21.Graziani M, Nistico R. Gender difference in prescription opioid abuse: A focus on oxycodone and hydrocodone. Pharmacol Res 2016 Apr 20;108:31-38.
- 22.Fine A, Churchill DN. Potentially lethal interaction of cimetidine and morphine. Can Med Assoc J 1981 Jun 1;124(11):1434-6.
- 23.Lam AM, Clement JL. Effect of cimetidine premedication on morphine-induced ventilatory depression. Can Anaesth Soc J 1984 Jan; 31(1):36-43.
- 24.Mojaverian P, Fedder IL, Vlasses PH, Rotmensch HH, Rocci ML Jr, Swanson BN, Ferguson RK. Cimetidine does not alter morphine disposition in man. Br J Clin Pharmacol 1982 Dec;14(6):809-13.
- 25.Dawson GW, Vestal RE. Cimetidine inhibits the in vitro N-demethylation of methadone. Res Commun Chem Pathol Pharmacol 1984 Nov;46(2):301-4.
- 26.Samer CF, Daali Y, Wagner M, Hopfgartner G, Eap CB, Rebsamen MC, Rossier MF, Hochstrasser D, Dayer P, Desmeules JA. The effects of CYP2D6 and CYP3A activities on the pharmacokinetics of immediate release oxycodone. Br J Pharmacol 2010 Jun;160(4):907-18.
- 27.Samer CF, Daali Y, Wagner M, Hopfgartner G, Eap CB, Rebsamen MC, Rossier MF, Hochstrasser D, Dayer P, Desmeules JA. Genetic polymorphisms and drug interactions modulating CYP2D6 and CYP3A activities have a major effect on oxycodone analgesic efficacy and safety. Br J Pharmacol 2010 Jun; 160(4):919-30.
- 28.Guay DR, Meatherall RC, Chalmers JL, Grahame GR. Cimetidine alters pethidine disposition in man. Br J Clin Pharmacol 1984 Dec;18(6):907-14.
- 29.Lam AM. Potentially lethal interaction of cimetidine and morphine. Can Med Assoc J 1981 Oct 15;125(8):820.
- 30.Philbin DM, Moss J, Akins CW, Rosow CE, Kono K, Schneider RC, VerLee TR, Savarese JJ. The use of H1 and H2 histamine antagonists with morphine anesthesia: a double-blind study. Anesthesiology 1981 Sep;55(3):292-6.
- 31.Sorkin EM, Ogawa GS. Cimetidine potentiation of narcotic action. Drug Intell Clin Pharm 1983 Jan;17(1):60-1.
- 32.Mojaverian P, Swanson BN, Vlasses PH, Ferguson RK. Potentially lethal interaction of cimetidine and morphine. Can Med Assoc J 1981 Dec 1; 125(11):1212-3.
- 33.Fine A, Churchill DN. Potentially lethal interactions of cimetidine and morphine. Can Med Assoc J 1982 May 1;126(9):1032.
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.