title: Opioid pharmacokinetic drug-drug interactions.
abstract: Pharmacokinetic drug-drug interactions (DDIs) involving opioid analgesics can be problematic. Opioids are widely used, have a narrow therapeutic index, and can be associated with severe toxicity. The purpose of this review is to describe pharmacokinetic DDIs associated with opioids frequently encountered in managed care settings (morphine, codeine, oxycodone, oxymorphone, hydrocodone, hydromorphone, fentanyl, tramadol, and methadone). An introduction to the pharmacokinetic basis of DDIs is provided, and potential DDIs associated with opioids are reviewed. Opioids metabolized by the drug metabolizing enzymes of the cytochrome P450 (CYP450) system (codeine, oxycodone, hydrocodone, fentanyl, tramadol, and methadone) are associated with numerous DDIs that can result in either a reduction in opioid effect or excess opioid effects. Conversely, opioids that are not metabolized by that system (morphine, oxymorphone, and hydromorphone) tend to be involved in fewer CYP450-associated pharmacokinetic DDIs.
authors: Department of Pharmacy Practice, College of Pharmacy, Purdue University, 1001 West 10th St., Indianapolis, IN 46202, USA.
authors: Brian R
authors: BR
authors: Overholser
authors: David R
authors: DR
authors: Foster
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism*; D004347:Drug Interactions; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data; D010597:Pharmacogenetics
chemical_list: D000701:Analgesics, Opioid; D003577:Cytochrome P-450 Enzyme System