Drug Interactions between levothyroxine and Nucynta

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including tapentadol. 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 extended-release formulations of tapentadol may cause rapid release of the drug, resulting in high systemic levels of tapentadol that may be potentially lethal even in opioid-tolerant patients. Alcohol appears to disrupt the extended-release mechanism, causing 'dose-dumping' into the bloodstream. A clinical study evaluated healthy volunteers administered a single dose of extended-release tapentadol (100 mg or 250 mg) with 240 mL of 40% alcohol. The mean peak tapentadol concentration (Cmax) was 48% higher when alcohol was combined with the 100 mg dose and 28% higher when alcohol was combined with the 250 mg dose, as compared to control. Additionally, the systemic exposure (AUC) of tapentadol increased by 16-17% when combined with alcohol.

MANAGEMENT: Patients taking extended-release formulations of tapentadol should not consume alcohol or use medications that contain alcohol. In general, narcotics such as tapentadol should not be combined with alcohol. Modified and/or extended-release tapentadol formulations must also be swallowed whole and not crushed, chewed or divided.

The timing of meals relative to your oral levothyroxine dose can affect the absorption of the medication. Therefore, levothyroxine should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects. In addition, absorption of levothyroxine may be decreased and/or delayed by foods such as soybean flour, cotton seed meal, walnuts, dietary fiber, calcium, calcium fortified juices and grapefruit or grapefruit juice. These foods should be avoided within several hours of dosing if possible. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Using multivitamin with minerals together with levothyroxine may decrease the effects of levothyroxine. You should separate the administration of levothyroxine and multivitamin with minerals by at least 4 hours. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.