Decreased responsiveness to oxycodone: A case of a pharmacokinetic drug interaction?

Doreen Pon, PharmD; Joon Hwang, PharmD Candidate; Teresa Lo, PharmD Candidate; Carin Van Zyl, MD, FACEP

doi:10.5055/jom.2015.0284

Authors

Doreen Pon, PharmD
Joon Hwang, PharmD Candidate
Teresa Lo, PharmD Candidate
Carin Van Zyl, MD, FACEP

DOI:

https://doi.org/10.5055/jom.2015.0284

Keywords:

drug interaction, oxycodone, phenytoin, opioids, pain management

Abstract

Concurrent administration of oxycodone and phenytoin may cause, through induction of CYP3A4 enzymes, decreased analgesic effects of oxycodone. However, no descriptions of this interaction exist. A patient who was on oxycodone for chronic back pain was admitted to the hospital. Five days after initiating fosphenytoin, the patient experienced a dramatic escalation in his pain and lack of response to oxycodone breakthrough doses. Changing oxycodone to hydromorphone resulted in significantly improved analgesia. Concurrent use of fosphenytoin and oxycodone may increase the conversion of oxycodone to inactive metabolites, resulting in decreased analgesia. This may be avoided using hydromorphone, morphine, or oxymorphone.

Author Biographies

Doreen Pon, PharmD

Assistant Professor, Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California; Faculty in Residence, Department of Pharmacy, City of Hope National Medical Center, Duarte, California.

Joon Hwang, PharmD Candidate

College of Pharmacy, Western University of Health Sciences, Pomona, California.

Teresa Lo, PharmD Candidate

College of Pharmacy, Western University of Health Sciences, Pomona, California

Carin Van Zyl, MD, FACEP

Assistant Clinical Professor, Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California.

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