Basic Information
ID DDInter890 and DDInter690
Interaction Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including hydromorphone. 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. Consumption of alcohol while taking sustained-release formulations of hydromorphone may cause rapid release of the drug, resulting in high systemic levels of hydromorphone that may be potentially lethal even in opioid-tolerant patients. Alcohol appears to disrupt the extended release mechanism, causing 'dose-dumping' into the bloodstream.
Management Patients taking sustained-release formulations of hydromorphone should not consume alcohol or use medications that contain alcohol on days of hydromorphone dosing. In general, potent narcotics such as hydromorphone should not be combined with alcohol.
References [1] FDA. U.S. Food and Drug Administration "Healthcare Professional Sheet. FDA Alert [07/2005]: alcohol-palladone interaction. Available from: URL: http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone." ([2005 July 13]): [2] "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ. [3] Levine B, Saady J, Fierro M, Valentour J "A hydromorphone and ethanol fatality." J Forensic Sci 29 (1984): 655-9 [4] FDA. U.S. Food and Drug Administration "Healthcare Professional Sheet. FDA Alert [07/2005]: alcohol-palladone interaction. Available from: URL: http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Palladone." ([2005 July 13]): [5] Levine B, Saady J, Fierro M, Valentour J "A hydromorphone and ethanol fatality." J Forensic Sci 29 (1984): 655-9 [6] "Product Information. Dilaudid (hydromorphone)." Knoll Pharmaceutical Company, Whippany, NJ.
Alternative for Hydromorphone N02A
Naloxone Celecoxib
Alternative for Ethanol V03A
Calcium acetate Hydroxocobalamin Amifostine Fomepizole Dexrazoxane Levoleucovorin
Arginine Physostigmine Oxygen Trilaciclib Palifermin
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.