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Drug Interactions between levomethadyl acetate and mebrofenin

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

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Moderate

levomethadyl acetate mebrofenin

Applies to: levomethadyl acetate and 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

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Drug and food interactions

Major

levomethadyl acetate food

Applies to: levomethadyl acetate

GENERALLY AVOID: The concurrent use of levomethadyl acetate and alcohol may result in additive CNS and respiratory depression, hypotension, sedation, or coma. Grapefruit juice may increase the plasma concentrations of orally administered drugs which are substrates of the CYP450 3A4 isoenzyme, such as levomethadyl acetate. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The extent and clinical significance are unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.

MANAGEMENT: Patients who are known to abuse alcohol should be warned of the risk of potentially fatal overdose if these substances are taken concurrently. Patients who regularly consume grapefruits and grapefruit juice should be monitored for adverse effects and altered plasma concentrations of levomethadyl acetate. A 12-lead ECG should be performed before initiating therapy, 12 to 14 days after initiating therapy, and periodically thereafter. Patients should be advised to immediately seek medical attention if they experience palpitations, dizziness, lightheadedness, fainting, or seizures. Grapefruits and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact.

References

  1. (2001) "Product Information. Orlaam (levomethadyl acetate)." Roxane Laboratories Inc

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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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