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Drug Interactions between Hycodan and sodium oxybate

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

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Interactions between your drugs

Major

HYDROcodone sodium oxybate

Applies to: Hycodan (homatropine / hydrocodone) and sodium oxybate

GENERALLY AVOID: The central nervous system and respiratory depressant effects of sodium oxybate, which is the sodium salt of gamma hydroxybutyrate (GHB), may be potentiated by concomitant use of other agents with CNS depressant effects. An increased risk of serious adverse reactions such as respiratory depression, hypotension, profound sedation, syncope, coma, and even death should be considered.

MANAGEMENT: Concomitant use of sodium oxybate with other CNS depressants should be avoided whenever possible. Otherwise, close monitoring and/or dosage reductions should be considered. If short-term use of a CNS depressant is required (e.g., post- or perioperative opioid), a temporary interruption of sodium oxybate therapy may be appropriate. All patients treated with sodium oxybate should be advised not to drive, operate machinery, or engage in hazardous activities requiring mental alertness and motor coordination for at least 6 hours after taking the second nightly dose of sodium oxybate and until they know how the medication affects them.

References (3)
  1. (2002) "Product Information. Xyrem (sodium oxybate)." Orphan Medical
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. (2020) "Product Information. Xywav (calcium/magnesium/potass/sodium oxybates)." Jazz Pharmaceuticals
Moderate

HYDROcodone homatropine

Applies to: Hycodan (homatropine / hydrocodone) and Hycodan (homatropine / hydrocodone)

MONITOR: Coadministration of opioids with anticholinergic agents may result in additive central nervous system (CNS), gastrointestinal, and genitourinary effects. The risk and/or severity of adverse effects such as sedation, dizziness, confusion, cognitive and psychomotor impairment, dry mouth, constipation, and urinary retention may increase. Severe constipation may lead to paralytic ileus in some cases.

MANAGEMENT: Caution and close monitoring of central nervous system, gastrointestinal, and genitourinary adverse effects are recommended when opioids are used with anticholinergic agents. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References (19)
  1. (2002) "Product Information. Demerol (meperidine)." Sanofi Winthrop Pharmaceuticals
  2. (2002) "Product Information. Dolophine (methadone)." Lilly, Eli and Company
  3. (2001) "Product Information. Tylenol with Codeine (acetaminophen-codeine)." Janssen Pharmaceuticals
  4. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  5. (2001) "Product Information. Ultram (tramadol)." McNeil Pharmaceutical
  6. (2001) "Product Information. OxyContin (oxycodone)." Purdue Frederick Company
  7. (2001) "Product Information. Kadian (morphine)." Astra-Zeneca Pharmaceuticals
  8. (2004) "Product Information. DepoDur (morphine liposomal)." Endo Laboratories LLC
  9. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  10. (2006) "Product Information. Opana (oxymorphone)." Endo Laboratories LLC
  11. (2009) "Product Information. Nucynta (tapentadol)." PriCara Pharmaceuticals
  12. (2010) "Product Information. Exalgo (hydromorphone)." Covidien
  13. (2016) "Product Information. Belbuca (buprenorphine)." Endo Pharmaceuticals Solutions Inc
  14. (2017) "Product Information. Alfentanil Hydrochloride (alfentanil)." Akorn Inc
  15. (2017) "Product Information. SUFentanil Citrate (sufentanil)." Akorn Inc
  16. (2017) "Product Information. Lortab (acetaminophen-hydrocodone)." Akorn Inc
  17. (2017) "Product Information. Levorphanol Tartrate (levorphanol)." Sentynl Therapeutics
  18. (2018) "Product Information. Naloxone HCl-Pentazocine HCl (naloxone-pentazocine)." Actavis U.S. (Amide Pharmaceutical Inc)
  19. (2018) "Product Information. Apadaz (acetaminophen-benzhydrocodone)." KemPharm, Inc

Drug and food interactions

Major

HYDROcodone food

Applies to: Hycodan (homatropine / hydrocodone)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydrocodone. 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 some sustained-release formulations of hydrocodone may cause rapid release of the drug, resulting in high systemic levels of hydrocodone that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. In study subjects, the rate of absorption of hydrocodone from an extended-release formulation was found to be affected by coadministration with 40% alcohol in the fasted state, as demonstrated by an average 2.4-fold (up to 3.9-fold in one subject) increase in hydrocodone peak plasma concentration and a decrease in the time to peak concentration. Alcohol also increased the extent of absorption by an average of 1.2-fold (up to 1.7-fold in one subject).

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of hydrocodone. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism of hydrocodone by certain compounds present in grapefruit. Increased hydrocodone concentrations could conceivably increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.

MANAGEMENT: Patients taking sustained-release formulations of hydrocodone should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as hydrocodone should not be combined with alcohol. Patients should also avoid consumption of grapefruit or grapefruit juice during treatment with hydrocodone.

References (1)
  1. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc
Major

sodium oxybate food

Applies to: sodium oxybate

CONTRAINDICATED: Alcohol may potentiate the central nervous system and respiratory depressant effects of sodium oxybate, which is the sodium salt of gamma hydroxybutyrate (GHB). An increased risk of serious adverse reactions such as respiratory depression, hypotension, profound sedation, syncope, coma, and even death should be anticipated.

ADJUST DOSING INTERVAL: Food may delay the absorption and significantly decrease the bioavailability of sodium oxybate. When sodium oxybate was administered immediately after a high-fat meal, the time to reach peak plasma concentration (Tmax) increased from 0.75 hour to 2 hours, the peak plasma concentration (Cmax) decreased by a mean of 59%, and the systemic exposure (AUC) decreased by a mean of 37%.

MANAGEMENT: The concomitant use of sodium oxybate with alcohol is considered contraindicated. The first dose of sodium oxybate should be taken at least 2 hours after a meal to ensure maximal absorption.

References (1)
  1. (2002) "Product Information. Xyrem (sodium oxybate)." Orphan Medical

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

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

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