Pharmacokinetic interaction of propoxyphene with ethanol

Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials

Alcohol and other xenobiotics may limit the therapeutic effects of medications. We aimed at investigating alcohol-medication interactions (AMI) after the exclusion of confounding effects related to other xenobiotics. We performed a systematic review and meta-analysis of controlled studies comparing the effects induced by alcohol versus placebo on pharmacodynamic and/or pharmacokinetic parameters of approved medications. Certainty in the evidence of AMI was assessed when at least 3 independent studies and at least 200 participants were available. We included 107 articles (3097 participants): for diazepam, cannabis, opioids, and methylphenidate, we found significant AMI and enough data to assign the certainty of evidence. Alcohol consumption significantly increases the peak plasma concentration of diazepam (low certainty; almost 290 participants), cannabis (high certainty; almost 650 participants), opioids (low certainty; 560 participants), and methylphenidate (moderate certainty; 290 participants). For most medications, we found some AMI but not enough data to assign them the certainty grades; for some medications, we found no differences between alcohol and placebo in any outcomes evaluated. Our results add further evidence for interactions between alcohol and certain medications after the exclusion of confounding effects related to other xenobiotics. Physicians should advise patients who use these specific medications to avoid alcohol consumption. Further studies with appropriate control groups, enough female participants to investigate sex differences, and elderly population are needed to expand our knowledge in this field. Short phrases suitable for indexing terms.

Evaluation of the safety, pharmacodynamic, and pharmacokinetic effects following oral coadministration of immediate-release morphine with ethanol in healthy male participants

OBJECTIVE

This paper aimed to evaluate the effects of coadministered immediate-release morphine and ethanol on safety, pharmacokinetic, and pharmacodynamic measures.

METHODS

In the first stage of a randomized, double-blind, placebo-controlled, crossover study, 16 healthy men with a history of moderate drinking received morphine 50 mg+ethanol 0.7 g/kg, morphine 50 mg+ethanol placebo, and morphine placebo+ethanol 0.7 g/kg. In the second stage, participants received either a lower (30 mg) or higher (80 mg) morphine dose (alone and in combination with ethanol) depending on their tolerability to treatments in stage 1. Safety, pharmacodynamic (including visual analog scales, pupillometry, capnography, and psychomotor and cognitive measures), and pharmacokinetic assessments were conducted.

RESULTS

With the exception of one severe adverse event (AE), all others were mild or moderate in intensity. Morphine resulted in dose-related increases in AEs. When morphine was administered with ethanol, similar AEs were observed (dizziness, headache, somnolence, nausea, and vomiting), but these were sometimes more frequent compared with those observed with either drug alone. No consistent additive or interaction effects were observed on pharmacodynamic measures. Ethanol had no apparent effects on the pharmacokinetics of morphine or its metabolites.

CONCLUSIONS

Coadministration of single doses of morphine and ethanol tested in this study did not affect the safety, pharmacodynamics, or pharmacokinetics of morphine or ethanol administered alone. Copyright © 2014 John Wiley & Sons, Ltd.

Subjective, psychomotor, and physiological effects of oxycodone alone and in combination with ethanol in healthy volunteers

RATIONALE

Nonmedical use of prescription opioids is sometimes accompanied by the ingestion of ethanol. Whether ethanol increases the abuse liability-related effects of prescription opioids has not been determined.

OBJECTIVE

The purpose of this study was to characterize the subjective, psychomotor, and physiological effects of oxycodone, a widely prescribed and abused opioid, and ethanol, alone and in combination.

METHODS

Fourteen volunteers participated in a randomized, crossover trial in which they were exposed to placebo, oxycodone (10 mg), two doses of ethanol (0.3 and 0.6 g/kg), and oxycodone combined with the lower dose and the higher dose of ethanol on separate sessions.

RESULTS

Several abuse liability-related subjective effects (drug liking, take again, pleasant bodily sensations) were not increased by the low dose of ethanol or oxycodone alone relative to placebo, but were when the two were combined. Self-reported liking of the higher dose of ethanol was higher than that of placebo, but oxycodone neither increased nor decreased this effect. Psychomotor and cognitive performance was not affected by any of the active drug conditions. Absorption of ethanol was decreased by oxycodone.

CONCLUSIONS

In this study, 10 mg of oral oxycodone combined with a low dose of ethanol generated abuse liability-related effects, but when tested separately, they did not. Further psychopharmacological investigations of this combination are warranted in light of these findings and the fact that nonmedical use of prescription opioids is sometimes accompanied by use of ethanol.

Dextropropoxyphene addiction--a drug of primary abuse

In order to establish a profile of the abuser of dextropropoxyphene (DPX) in our community, we reviewed all the records from the Detoxification Unit in the Mental Health Institute in Mexicali, Baja California, Mexico. A total of 209 records were reviewed, and 73 were included in our study. Those included had a diagnosis of DPX dependence according to DSM-III-R and no associated psychiatric pathology. Most of them were single, unemployed males, with a history of at least 4 years of continuous DPX abuse. They were consuming an average dose per day 3.5 times higher than the maximum therapeutic dose recommended. The onset of generalized seizures associated with the DPX abuse was confirmed in 53% of the cases. The drug most frequently abused along with DPX was a benzodiazepine (p < .01), followed by marijuana, heroin, alcohol, stimulants (cocaine and amphetamines), and inhalants; 17% of the cases were pure DPX abusers. DPX was the first opiate ever abused in 67% of the cases, 19% had abused heroin before DPX, and 14% started the use of both at the same time. The difference among these groups (p < .01) suggests DPX as an opiate of primary abuse and not as secondary to heroin dependence.

Enhancement of propoxyphene bioavailability by ethanol. Relation to psychomotor and cognitive function in healthy volunteers

The interaction between a single oral dose of 130 mg propoxyphene and 0.5 g/kg body weight ethanol was investigated in 12 healthy male volunteers by 9 objective performance tests, 8 visual analogue self-rating scales and the measurement of plasma propoxyphene, norpropoxyphene and ethanol concentrations, using a double-blind threeway crossover design. Volunteers were each given one of three treatments, propoxyphene + ethanol, placebo + ethanol and propoxyphene alone, separated by a two week interval. The performance tests were completed before and 1.25 and 4 h after drug intake, and the self-rating scales before and 1.25, 4 and 10 h after it. Ethanol was shown to enhance the bioavailability of propoxyphene by 25% probably by reducing its first-pass metabolism. However, despite this pharmacokinetic effect no pharmacodynamic interaction was found. Subjective ratings disclosed that the effect of ethanol on physical and mental sedation predominated over the effects of propoxyphene.

The effect of a single oral dose of ethanol on hepatic blood flow in man

The magnitude and time course of changes in hepatic blood flow following oral ingestion of a single (0.6 g/kg) dose of ethanol was studied using the model compound indocyanine green (ICG). Hepatic blood flow was not significantly different at 40, 90, 150 and 210 minutes following ethanol as compared to baseline values measured 20 and 70 min prior to alcohol ingestion. These results suggest that ethanol, at concentrations commonly associated with social drinking, has minimal effects on liver blood flow and would be expected to contribute little to changes in either the bioavailability or clearance of drugs highly extracted by the liver.

The effect of ethanol intake on propoxyphene absorption and biotransformation in dogs

The effect of ethanol (0.5 and 1.0 g/kg) on gastrointestinal absorption and presystemic biotransformation of propoxyphene (4 mg/kg) was studied in dogs in a crossover design. Low ethanol doses (0.5 g/kg) had no effect on the bioavailability of propoxyphene. High ethanol doses (1.0 g/kg) enhanced the bioavailability of orally administered propoxyphene significantly (p less than 0.05). With this dose of ethanol, the area under the blood concentration versus time curve (AUC)0-5 h of propoxyphene was approximately 200% of the control value. The level of norpropoxyphene, a major metabolite of propoxyphene, was significantly decreased (p less than 0.05) after administration of high ethanol doses. In all blood samples, after propoxyphene administration, an unidentified metabolite of propoxyphene was found, which formation was dose dependently inhibited by ethanol.