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 potentiate the central nervous system (CNS) depressant effects of opioid analgesics including buprenorphine. 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.

MANAGEMENT: Patients taking buprenorphine should not consume alcohol or use medications that contain alcohol on days of buprenorphine dosing. In general, potent narcotics such as buprenorphine should not be combined with alcohol.