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Drug Interactions between amifampridine and hydromorphone

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

HYDROmorphone amifampridine

Applies to: hydromorphone and amifampridine

MONITOR: The use of amifampridine is associated with a dose-related risk of seizures, and the risk may be further increased when coadministered with other drugs that can reduce the seizure threshold. Seizures have occurred in patients without a history of seizures taking amifampridine at recommended dosages and at various times after initiation of treatment. Reported incidence is approximately 2%. Many of the patients were taking medications or had comorbid medical conditions that may have lowered the seizure threshold.

MANAGEMENT: Caution is advised if amifampridine is coadministered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Consider discontinuation or dose reduction of amifampridine in patients who experience a seizure during treatment. Use of amifampridine is contraindicated in patients with a history of seizures.

References (2)
  1. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  2. (2018) "Product Information. Firdapse (amifampridine)." Catalyst Pharmaceuticals, Inc.

Drug and food interactions

Major

HYDROmorphone food

Applies to: hydromorphone

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydromorphone. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking sustained-release formulations of hydromorphone may cause rapid release of the drug, resulting in high systemic levels of hydromorphone that may be potentially lethal even in opioid-tolerant patients. Alcohol appears to disrupt the extended release mechanism, causing 'dose-dumping' into the bloodstream. In 48 healthy volunteers, coadministration of a 12 mg dose of sustained-release hydromorphone with 240 mL of 40% (80 proof) alcohol resulted in a mean peak hydromorphone concentration (Cmax) approximately six times greater than when taken with water. One subject had a 16-fold increase in hydromorphone Cmax with 40% alcohol compared to water. In some subjects, coadministration with 8 ounces of 4% alcohol (equivalent to 2/3 of a typical serving of beer) resulted in almost twice the hydromorphone Cmax than when coadministered with water. The effect of alcohol was more pronounced in a fasted state.

MANAGEMENT: Patients taking sustained-release formulations of hydromorphone should not consume alcohol or use medications that contain alcohol on days of hydromorphone dosing. In general, potent narcotics such as hydromorphone should not be combined with alcohol.

References (3)
  1. Levine B, Saady J, Fierro M, Valentour J (1984) "A hydromorphone and ethanol fatality." J Forensic Sci, 29, p. 655-9
  2. (2001) "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company
  3. FDA. U.S. Food and Drug Administration (2005) Healthcare Professional Sheet. FDA Alert [07/2005]: alcohol-palladone interaction. http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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