Skip to main content

Drug Interactions between Choletec and Subsys

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

fentaNYL mebrofenin

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

Switch to consumer interaction data

Drug and food interactions

Major

fentaNYL food

Applies to: Subsys (fentanyl)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including fentanyl. 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 grapefruit juice during treatment with oral transmucosal formulations of fentanyl may result in increased plasma concentrations of fentanyl, which is primarily metabolized by CYP450 3A4 isoenzyme in the liver and intestine. Certain compounds present in grapefruit are known to inhibit CYP450 3A4 and may increase the bioavailability of swallowed fentanyl (reportedly up to 75% of a dose) and/or decrease its systemic clearance. The clinical significance is unknown. In 12 healthy volunteers, consumption of 250 mL regular-strength grapefruit juice the night before and 100 mL double-strength grapefruit juice one hour before administration of oral transmucosal fentanyl citrate (600 or 800 mcg lozenge) did not significantly affect fentanyl pharmacokinetics, overall extent of fentanyl-induced miosis (miosis AUC), or subjective self-assessment of various clinical effects compared to control. However, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability. The possibility of significant interaction in some patients should be considered.

MANAGEMENT: Patients should not consume alcoholic beverages or use drug products that contain alcohol during treatment with fentanyl. Any history of alcohol or illicit drug use should be considered when prescribing fentanyl, 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 fentanyl should preferably avoid the consumption of grapefruit and grapefruit juice. In addition, patients receiving transdermal formulations of fentanyl should be cautioned that drug interactions and drug effects may be observed for a prolonged period beyond removal of the patch, as significant amounts of fentanyl are absorbed from the skin for 17 hours or more after the patch is removed.

References

  1. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  2. (2001) "Product Information. Actiq (fentanyl)." Abbott Pharmaceutical
  3. Kharasch ED, Whittington D, Hoffer C (2004) "Influence of Hepatic and Intestinal Cytochrome P4503A Activity on the Acute Disposition and Effects of Oral Transmucosal Fentanyl Citrate." Anesthesiology, 101, p. 729-737
  4. Tateishi T, Krivoruk Y, Ueng YF, Wood AJ, Guengerich FP, Wood M (1996) "Identification of human cytochrome P-450 3A4 as the enzyme responsible for fentanyl and sufentanil N-dealkylation." Anesth Analg, 82, p. 167-72
  5. Labroo RB, Paine MF, Thummel KE, Kharasch ED (1997) "Fentanyl metabolism by human hepatic and intestinal cytochrome P450 3A4: implicaitons for interindividual variability in disposition, efficacy, and drug interactions." Drug Metab Dispos, 25, p. 1072-80
View all 5 references

Switch to consumer interaction data

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.

See also

Report options

Loading...
QR code containing a link to this page

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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer