Drug Interaction Report

MONITOR: In clinical trials, patients on opioids often required higher serum pegvisomant concentrations to achieve appropriate IGF-I (insulin-like growth factor-I) suppression compared with patients not receiving opioids. The mechanism of interaction is unknown.

MANAGEMENT: Clinicians should be aware of this potential interaction and adjust the dosage of pegvisomant appropriately in patients treated with opioids.

GENERALLY AVOID: Alcohol may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.

MANAGEMENT: The use of alcohol during propoxyphene therapy should be avoided. Patients should be warned not to exceed the recommended dosage of propoxyphene and to avoid activities requiring mental alertness until they know how these agents affect them.