Drug Interactions in Palliative Care
- 8 April 2000
- journal article
- review article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 18 (8) , 1780-1799
- https://doi.org/10.1200/jco.2000.18.8.1780
Abstract
PURPOSE: This review of drug interactions in palliative care examines the relevant literature in this area and summarizes the information on interactions of drugs, nutrients, and natural products that are used in the palliative care setting. Particular emphasis is placed on describing the newer information on the cytochrome P450 (CYP) system and the interactions of opioids, antidepressants, and the antitussive, dextromethorphan.METHODS: We performed a search of the MEDLINE database of the time period from 1966 until April 1998, using medical subject headings such as the names of selective serotonin reuptake inhibitors and other relevant medications in palliative care. Literature reviewed included both human and animal articles as well as non-English literature. Bibliographies of these articles and the personal libraries of several palliative care specialists were reviewed. Software developed by The Medical Letter—The Drug Interaction Program was also used.RESULTS: Drug interactions can be categorized in several ways. Drug-drug interactions are the most well known and can be kinetic, dynamic, or pharmaceutical. Pharmacokinetic interactions can involve CYP 2D6, which acts on drugs such as codeine and is responsible for its conversion to morphine. Poor metabolizers, either genotypic or due to phenocopying, are at risk for undertreatment if not recognized. Pharmacodynamic interactions with dextromethorphan may produce serotonin syndrome.CONCLUSION: Drug interactions are important in palliative care as in other aspects of medicine. These interactions are similar to those seen in other areas of medical care but have significant consequences in pain management. Failure to recognize these interactions can lead to either overdosing or undertreatment.Keywords
This publication has 117 references indexed in Scilit:
- Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodoneJournal of Pain and Symptom Management, 1996
- Macrolide AntibacterialsDrug Safety, 1995
- Drug Interactions and the Cytochrome P450 SystemClinical Pharmacokinetics, 1995
- Antidepressant Drug Interactions and the Cytochrome P450 SystemClinical Pharmacokinetics, 1995
- P450 EnzymesClinical Pharmacokinetics, 1992
- Clinical Pharmacokinetics of CyclophosphamideClinical Pharmacokinetics, 1991
- Interaction between Dextromethorphan and Monoamine Oxidase Inhibitor Therapy with IsocarboxazidNew England Journal of Medicine, 1988
- The Polymorphic Metabolism of DextromethorphanThe Journal of Clinical Pharmacology, 1987
- Pharmacokinetic Drug Interactions of Commonly Used Anticancer DrugsClinical Pharmacokinetics, 1986
- Carbamazepine Metabolism in ManClinical Pharmacokinetics, 1985