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Drug Interactions between Choletec and ETH-Oxydose

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

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Interactions between your drugs

Moderate

oxyCODONE mebrofenin

Applies to: ETH-Oxydose (oxycodone) and Choletec (mebrofenin)

MONITOR: Prior administration of opioids may delay transit of Technetium Tc 99m mebrofenin due to opioid-induced contraction of the distal common bile duct, which may result in nonvisualization. In one study, a group of investigators reviewed the records of 198 emergency department patients who underwent nuclear hepatobiliary imaging, after excluding those with evidence for pathologic common bile duct (CBD) obstruction. Delayed CBD visualization occurred in 28.6% of subjects who had received opioids (n=56) and 12.0% of subjects who had not received opioids, while delayed imaging was performed in 77.8% and 53.5%, respectively. The relative risk of delayed CBD visualization was 1.46 for meperidine, 4.18 for morphine, and 2.38 for any opioid. Nonetheless, low-dose intravenous morphine has been used during cholescintigraphy to increase biliary pressure, thereby allowing for visualization of gallbladder when there is failure to visualize 60 minutes or more after Technetium Tc 99m mebrofenin injection. Compared to standard cholescintigraphy, morphine-augmented cholescintigraphy has been shown to reduce imaging time and the number of false-positive results.

MANAGEMENT: Nonvisualization may occur in patients who have been receiving opioids prior to cholescintigraphy.

References

  1. "Product Information. Choletec (mebrofenin)." Bracco Diagnostics Inc (2012):
  2. Kim EE, Pjura G, Lowry P, Nguyen M, Pollack M "Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis." AJR Am J Roentgenol 147 (1986): 1177-9
  3. Fink-Bennett D, Balon H, Robbins T, Tsai D "Morphine-augmented cholescintigraphy: its efficacy in detecting acute cholecystitis." J Nucl Med 32 (1991): 1231-3
  4. Flancbaum L, Choban PS, Sinha R, Jonasson O "Morphine cholescintigraphy in the evaluation of hospitalized patients with suspected acute cholecystitis." Ann Surg 220 (1994): 25-31
  5. Chen CC, Holder LE, Maunoury C, Drachenberg CI "Morphine augmentation increases galllbladder visualization in patients pretreated with cholecystokinin." J Nucl Med 38 (1997): 644-7
  6. Oates E, Selland DL, Chin CT, Achong DM "Gallbladder nonvisualization with pericholecystic rim sign: morphine-augmentation optimizes diagnosis of acute cholecystitis." J Nucl Med 37 (1996): 267-9
View all 6 references

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Drug and food interactions

Major

oxyCODONE food

Applies to: ETH-Oxydose (oxycodone)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including oxycodone. 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: Grapefruit juice may increase the plasma concentrations of oxycodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of oxycodone by certain compounds present in grapefruit, resulting in decreased formation of metabolites noroxycodone and noroxymorphone and increased formation of oxymorphone due to a presumed shifting of oxycodone metabolism towards the CYP450 2D6-mediated route. In 12 healthy, nonsmoking volunteers, administration of a single 10 mg oral dose of oxycodone hydrochloride on day 4 of a grapefruit juice treatment phase (200 mL three times a day for 5 days) increased mean oxycodone peak plasma concentration (Cmax), systemic exposure (AUC) and half-life by 48%, 67% and 17% (from 3.5 to 4.1 hours), respectively, compared to administration during an equivalent water treatment phase. Grapefruit juice also decreased the metabolite-to-parent AUC ratio of noroxycodone by 44% and that of noroxymorphone by 45%. In addition, oxymorphone Cmax and AUC increased by 32% and 56%, but the metabolite-to-parent AUC ratio remained unchanged. Pharmacodynamic changes were modest and only self-reported performance was significantly impaired after grapefruit juice. Analgesic effects were not affected.

MANAGEMENT: Patients should not consume alcoholic beverages or use drug products that contain alcohol during treatment with oxycodone. Any history of alcohol or illicit drug use should be considered when prescribing oxycodone, and therapy initiated at a lower dosage if necessary. Patients should be closely monitored for signs and symptoms of sedation, respiratory depression, and hypotension. Due to a high degree of interpatient variability with respect to grapefruit juice interactions, patients treated with oxycodone may also want to avoid or limit the consumption of grapefruit and grapefruit juice.

References

  1. Nieminen TH, Hagelberg NM, Saari TI, et al. "Grapefruit juice enhances the exposure to oral oxycodone." Basic Clin Pharmacol Toxicol 107 (2010): 782-8

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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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