Skip to main content

Drug Interactions between Dilaudid and ozanimod

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

HYDROmorphone ozanimod

Applies to: Dilaudid (hydromorphone) and ozanimod

GENERALLY AVOID: Coadministration of opioid analgesics with drugs that possess monoamine oxidase inhibition (MAOI) activity, including selective MAO-B inhibitors, has been associated with rare reports of severe and sometimes fatal adverse reactions. Because an active metabolite of ozanimod inhibits MAO-B in vitro, the interaction may theoretically occur with ozanimod. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases. In contrast, symptoms of the depressive reaction probably stem from potentiation of CNS effects by MAOIs and include respiratory depression, cyanosis, hypotension, and coma. There have also been reports of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors, with symptoms similar to the excitatory reaction described above. Some opioids such as fentanyl, meperidine, methadone, tapentadol, and tramadol can inhibit serotonin reuptake and are more likely to cause serotonin syndrome. However, serotonin syndrome has also occurred with other opioids.

MANAGEMENT: Until more information is available, concomitant use of ozanimod with opioid analgesics should be avoided when possible. Blood pressure and other vitals should be monitored if coadministration is required.

References

  1. Browne B, Linter S "Monoamine oxidase inhibitors and narcotic analgesics: a critical review of the implications for treatment." Br J Psychiatry 151 (1987): 210-2
  2. Zornberg GL, Bodkin JA, Cohen BM "Severe adverse interaction between pethidine and selegiline." Lancet 337 (1991): 246
  3. Pettinger WA, Soyangco FG, Oates JA "Inhibition of monoamine oxidase in man by furazolidone." Clin Pharmacol Ther 9 (1968): 442-7
  4. Schulz R, Antonin KH, Hoffmann E, et al. "Tyramine kinetics and pressor sensitivity during monoamine oxidase inhibition by selegiline." Clin Pharmacol Ther 46 (1989): 528-36
  5. Evans-Prosser CD "The use of pethidine and morphine in the presence of monoamine oxidase inhibitors." Br J Anaesth 40 (1968): 279-82
  6. Goldberg LI "Monoamine oxidase inhibitors: adverse reactions and possible mechanisms." JAMA 190 (1964): 456-62
  7. Vigran IM "Dangerous potentiation of meperidine hydrochloride by pargyline hydrochloride." JAMA 187 (1964): 953-4
  8. Nierenberg DW, Semprebon M "The central nervous system serotonin syndrome." Clin Pharmacol Ther 53 (1993): 84-8
  9. "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals PROD (2002):
  10. "Product Information. MS Contin (morphine)." Purdue Frederick Company PROD (2002):
  11. "Product Information. Roxicodone (oxycodone)." Roxane Laboratories Inc PROD (2001):
  12. Sternbach H "The serotonin syndrome." Am J Psychiatry 148 (1991): 705-13
  13. Starr C "Interaction between pethidine and selegiline." Lancet 337 (1991): 554
  14. "Product Information. Levo-Dromoran (levorphanol)." Roche Laboratories PROD (2001):
  15. Youssef MS, Wilkinson PA "Epidural fentanyl and monoamine oxidase inhibitors." Anaesthesia 43 (1988): 210-2
  16. Noble WH, Baker A "MAO inhibitors and coronary artery surgery: a patient death." Can J Anaesth 39 (1992): 1061-6
  17. "Product Information. Eldepryl (selegiline)." Somerset Pharmaceuticals Inc PROD (2001):
  18. Insler SR, Kraenzler EJ, Licina MG, Savage RM, Starr NJ "Cardiac surgery in a patient taking monoamine oxidase inhibitors - an adverse fentanyl reaction." Anesth Analg 78 (1994): 593-7
  19. Garbutt JC "Potentiation of propoxyphene by phenelzine." Am J Psychiatry 144 (1987): 251-2
  20. Zornberg GL, Hegarty JD "Adverse interaction between propoxyphene and phenelzine." Am J Psychiatry 150 (1993): 1270-1
  21. "Product Information. Tylenol with Codeine (acetaminophen-codeine)." Janssen Pharmaceuticals PROD (2001):
  22. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Ultram (tramadol)." McNeil Pharmaceutical PROD (2001):
  24. Limbird LE eds., Gilman AG, Hardman JG "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill (1995):
  25. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  26. "Product Information. Matulane (procarbazine)." Roche Laboratories PROD (2001):
  27. De Vita VT, Hahn MA, Oliverio VT "Monoamine oxidase inhibition by a new carcinostatic agent, n-isopropyl-a-(2-methylhydrazino)-p-toluamide (MIH). (30590)." Proc Soc Exp Biol Med 120 (1965): 561-5
  28. Fischer P "Serotonin syndrome in the elderly after antidepressive monotherapy." J Clin Psychopharmacol 15 (1995): 440-2
  29. Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2
  30. Michaels I, Serrins M, Shier NQ, Barash PG "Anesthesia for cardiac surgery in patients receiving monoamine oxidase inhibitors." Anesth Analg 63 (1984): 1041-4
  31. Staufenberg EF, Tantam D "Malignant hyperpyrexia syndrome in combined treatment." Br J Psychiatry 154 (1989): 577-8
  32. Mason BJ, Blackburn KH "Possible serotonin syndrome associated with tramadol and sertraline coadministration." Ann Pharmacother 31 (1997): 175-7
  33. Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
  34. "Product Information. Furoxone (furazolidone)." Roberts Pharmaceutical Corporation PROD (2001):
  35. "Product Information. Actiq (fentanyl)." Abbott Pharmaceutical PROD (2001):
  36. Chan BSH, Graudins A, Whyte IM, Dawson AH, Braitberg G, Duggin GG "Serotonin syndrome resulting from drug interactions." Med J Aust 169 (1998): 523-5
  37. "Product Information. Nubain (nalbuphine)." Endo Laboratories LLC PROD (2001):
  38. Egberts AC, ter Borg J, Brodie-Meijer CC "Serotonin syndrome attributed to tramadol addition to paroxetine therapy." Int Clin Psychopharmacol 12 (1997): 181-2
  39. "Product Information. Nardil (phenelzine)." Parke-Davis PROD (2001):
  40. "Product Information. Buprenex (buprenorphine)." Reckitt and Colman Pharmaceuticals Inc PROD (2001):
  41. "Product Information. Parnate (tranylcypromine)." SmithKline Beecham PROD (2001):
  42. Weiner AL "Meperidine as a potential cause of serotonin syndrome in the emergency department." Acad Emerg Med 6 (1999): 156-8
  43. Upton R, Graff A, Williamson E, et al. "American Herbal Pharmacopoeia and Therapeutic Compendium. Monograph printed in Herbalgram." Herbalgram 40 (1997): 1-38(monograph)
  44. "Product Information. Marplan (isocarboxazid)." Roche Laboratories PROD (2001):
  45. "Product Information. Meperidine Hydrochloride (meperidine)." Astra-Zeneca Pharmaceuticals (2022):
  46. Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
  47. Gillman PK "Possible serotonin syndrome with moclobemide and pethidine." Med J Aust 162 (1995): 554
  48. Gillman PK "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity." Br J Anaesth (2005):
  49. "Product Information. Emsam (selegiline)." Bristol-Myers Squibb (2006):
  50. Bodner RA, Lynch T, Lewis L, Kahn D "Serotonin syndrome." Neurology 45 (1995): 219-23
  51. "Product Information. Talacen (acetaminophen-pentazocine)." Sanofi-Synthelabo Inc (2006):
  52. "Product Information. Azilect (rasagiline)." Teva Pharmaceuticals USA (2006):
  53. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  54. Das PK, Warkentin DI, Hewko R, Forrest DL "Serotonin syndrome after concomitant treatment with linezolid and meperidine." Clin Infect Dis 46 (2008): 264-5
  55. Cerner Multum, Inc. "Australian Product Information." O 0
  56. "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals (2009):
  57. "Product Information. Methylene Blue (methylene blue)." American Regent Laboratories Inc (2012):
  58. "Product Information. Zeposia (ozanimod)." Celgene Corporation (2020):
View all 58 references

Switch to consumer interaction data

Drug and food interactions

Major

HYDROmorphone food

Applies to: Dilaudid (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

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

Switch to consumer interaction data

Moderate

ozanimod food

Applies to: ozanimod

GENERALLY AVOID: Foods that contain large amounts of tyramine may precipitate a hypertensive crisis in patients treated with ozanimod. The proposed mechanism involves potentiation of the tyramine pressor effect due to inhibition of monoamine oxidase (MAO) by the major active metabolites of ozanimod, CC112273 and CC1084037. Monoamine oxidase in the gastrointestinal tract and liver, primarily type A (MAO-A), is the enzyme responsible for metabolizing exogenous amines such as tyramine and preventing them from being absorbed intact. Once absorbed, tyramine is metabolized to octopamine, a substance that is believed to displace norepinephrine from storage granules causing a rise in blood pressure. In vitro, CC112273 and CC1084037 inhibited MAO-B (IC50 values of 5.72 nM and 58 nM, respectively) with more than 1000-fold selectivity over MAO-A (IC50 values >10000 nM). Because of this selectivity, as well as the fact that free plasma concentrations of CC112273 and CC1084037 are less than 8% of the in vitro IC50 values for MAO-B inhibition, ozanimod is expected to have a much lower propensity to cause hypertensive crises than nonselective MAO inhibitors. However, rare cases of hypertensive crisis have occurred during clinical trials for the treatment of multiple sclerosis (MS) and ulcerative colitis (UC) and in postmarketing use. In controlled clinical trials, hypertension and blood pressure increases were reported more frequently in patients treated with ozanimod (up to 4.6% in MS patients receiving ozanimod 0.92 mg/day) than in patients treated with interferon beta-1a (MS) or placebo (UC).

Administration of ozanimod with either a high-fat, high-calorie meal (1000 calories; 50% fat) or a low-fat, low-calorie meal (300 calories; 10% fat) had no effects on ozanimod peak plasma concentration (Cmax) and systemic exposure (AUC) compared to administration under fasted conditions.

MANAGEMENT: Dietary restriction is not ordinarily required during ozanimod treatment with respect to most foods and beverages that contain tyramine, which usually include aged, fermented, cured, smoked, or pickled foods (e.g., air-dried and fermented meats or fish, aged cheeses, most soybean products, yeast extracts, red wine, beer, sauerkraut). However, certain foods like some of the aged cheeses (e.g., Boursault, Liederkrantz, Mycella, Stilton) and pickled herring may contain very high amounts of tyramine and could potentially cause a hypertensive reaction in patients taking ozanimod, even at recommended dosages, due to increased sensitivity to tyramine. Patients should be advised to avoid the intake of very high levels of tyramine (e.g., greater than 150 mg) and to promptly seek medical attention if they experience potential signs and symptoms of a hypertensive crisis such as severe headache, visual disturbances, confusion, stupor, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Blood pressure should be regularly monitored and managed accordingly. Because of the long elimination half-lives of the major active metabolites, these precautions may need to be observed for up to 3 months following the last ozanimod dose. Ozanimod can be administered with or without food.

References

  1. "Product Information. Zeposia (ozanimod)." Celgene Pty Ltd (2022):
  2. "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb (2023):
  3. "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb Canada Inc (2023):
  4. "Product Information. Zeposia (ozanimod)." Bristol-Myers Squibb Pharmaceuticals Ltd (2023):
  5. Choi DK, Rubin DT, Puangampai A, Cleveland N "Hypertensive emergency after initiating ozanimod: a case report." Inflamm Bowel Dis 28 (2022): e114-5
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