Skip to main content

Drug Interactions between hydrocodone / ibuprofen and phenylbutazone

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

ibuprofen phenylbutazone

Applies to: hydrocodone / ibuprofen and phenylbutazone

GENERALLY AVOID: Concomitant use of more than one nonsteroidal anti-inflammatory drug (NSAID) at a time may increase the potential for serious gastrointestinal toxicity including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, or intestines. These events can occur at any time during NSAID use, with or without warning symptoms. The risk is dependent on both dosage and duration of therapy. Patients with a prior history of peptic ulcer disease and/or GI bleeding have a greater than 10-fold increased risk of developing a GI bleed during NSAID use compared to patients without a history. Additional risk factors include old age, alcohol use, smoking, and poor general health status.

MANAGEMENT: Concomitant use of more than one NSAID at a time should generally be avoided. Some authorities consider the concomitant use of more than one NSAID at a time to be contraindicated due to the absence of any evidence demonstrating synergistic benefits and the potential for additive adverse reactions (AU,UK). Patients treated with an NSAID should be advised to take it with food and to immediately report signs and symptoms of GI ulceration and bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools. The selective use of prophylactic anti-ulcer therapy (e.g., antacids, misoprostol, proton pump inhibitors) may be considered in high risk patients.

References (17)
  1. (2002) "Product Information. Nalfon (fenoprofen)." Xspire Pharma
  2. (2002) "Product Information. Indocin (indomethacin)." Merck & Co., Inc
  3. (2002) "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc
  4. (2006) "Product Information. Anaprox (naproxen)." Roche Laboratories
  5. (2001) "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories
  6. (2001) "Product Information. Daypro (oxaprozin)." Searle
  7. (2001) "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim
  8. (2006) "Product Information. Ponstel (mefenamic acid)." Pfizer U.S. Pharmaceuticals Group
  9. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  10. Cerner Multum, Inc. "Australian Product Information."
  11. (2009) "Product Information. Cambia (diclofenac)." Kowa Pharmaceuticals America (formerly ProEthic)
  12. (2009) "Product Information. Caldolor (ibuprofen)." Cumberland Pharmaceuticals Inc
  13. (2010) "Product Information. VIMOVO (esomeprazole-naproxen)." Astra-Zeneca Pharmaceuticals
  14. (2011) "Product Information. Duexis (famotidine-ibuprofen)." Horizon Therapeutics USA Inc
  15. (2012) "Product Information. Meclofenamate Sodium (meclofenamate)." Mylan Pharmaceuticals Inc
  16. (2016) "Product Information. Etodolac ER (etodolac)." Taro Pharmaceuticals U.S.A. Inc
  17. (2016) "Product Information. Ketoprofen ER (ketoprofen)." Mylan Pharmaceuticals Inc
Moderate

phenylbutazone HYDROcodone

Applies to: phenylbutazone and hydrocodone / ibuprofen

MONITOR: Coadministration with inducers of CYP450 3A4 may decrease the plasma concentrations of opioids that are metabolized by the isoenzyme such as butorphanol, fentanyl, hydrocodone, methadone, and oxycodone. Reduced efficacy or withdrawal symptoms may occur in patients maintained on their narcotic pain regimen following the addition of a CYP450 3A4 inducer. Conversely, discontinuation of the inducer may increase opioid plasma concentrations and potentiate the risk of overdose and fatal respiratory depression.

MANAGEMENT: Pharmacologic response to the opioid should be monitored more closely whenever a CYP450 3A4 inducer is added to or withdrawn from therapy, and the opioid dosage adjusted as necessary.

References (19)
  1. Holmes VF (1991) "Rifampin-induced methadone withdrawal in AIDS." J Clin Psychopharmacol, 10, p. 443-4
  2. Liu S-J, Wang RI (1984) "Case report of barbiturate-induced enhancement of methadone metabolism and withdrawal syndrome." Am J Psychiatry, 141, p. 1287-8
  3. Bell J, Seres V, Bowron P, Lewis J, Batey R (1988) "The use of serum methadone levels in patients receiving methadone maintenance." Clin Pharmacol Ther, 43, p. 623-9
  4. Finelli PF (1976) "Phenytoin and methadone tolerance." N Engl J Med, 294, p. 227
  5. Tong TG, Pond SM, Kreek MJ, et al. (1981) "Phenytoin-induced methadone withdrawal." Ann Intern Med, 94, p. 349-51
  6. Kreek MJ, Garfield JW, Gutjahr CL, Giusti LM (1976) "Rifampin-induced methadone withdrawal." N Engl J Med, 294, p. 1104-6
  7. Bending MR, Skacel PO (1977) "Rifampicin and methadone withdrawal." Lancet, 1, p. 1211
  8. "Product Information. Duragesic Transdermal System (fentanyl)." Janssen Pharmaceutica, Titusville, NJ.
  9. (2001) "Product Information. OxyContin (oxycodone)." Purdue Frederick Company
  10. Raistrick D, Hay A, Wolff K (1996) "Methadone maintenance and tuberculosis treatment." BMJ, 313, p. 925-6
  11. Altice FL, Friedland GH, Cooney EL (1999) "Nevirapine induced opiate withdrawal among injection drug users with HIV infection receiving methadone." AIDS, 13, p. 957-62
  12. Otero MJ, Fuertes A, Sanchez R, Luna G (1999) "Nevirapine-induced withdrawal symptoms in HIV patients on methadone maintenance programme: an alert." AIDS, 13, p. 1004-5
  13. Pinzani V, Faucherre V, Peyriere H, Blayac JP (2000) "Methadone withdrawal symptoms with nevirapine and efavirenz." Ann Pharmacother, 34, p. 405-7
  14. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  15. (2006) "Product Information. Ionsys (fentanyl)." Ortho McNeil Pharmaceutical
  16. (2007) "Product Information. Diskets (methadone)." Cebert Pharmaceuticals Inc
  17. Cerner Multum, Inc. "Australian Product Information."
  18. (2013) "Product Information. Zohydro ER (hydrocodone)." Zogenix, Inc
  19. (2017) "Product Information. Butorphanol Tartrate (butorphanol)." Apotex Corporation

Drug and food interactions

Major

HYDROcodone food

Applies to: hydrocodone / ibuprofen

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
Moderate

ibuprofen food

Applies to: hydrocodone / ibuprofen

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References (1)
  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Nonsteroidal anti-inflammatories

Therapeutic duplication

The recommended maximum number of medicines in the 'nonsteroidal anti-inflammatories' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'nonsteroidal anti-inflammatories' category:

  • hydrocodone/ibuprofen
  • phenylbutazone

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

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