Hydrocodone with alcohol
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Hydrocodone and Alcohol: Risks and Pharmacokinetics
Hydrocodone Extended-Release and Alcohol Interaction
Pharmacokinetics of Hydrocodone ER with Alcohol
Hydrocodone extended-release (ER) formulations are designed to release the drug slowly over time, reducing the risk of abuse and overdose. Studies have shown that hydrocodone ER tablets, formulated with CIMA® Abuse-Deterrence Technology, are resistant to dose dumping when taken with alcohol. In a study involving 40 healthy adults, the systemic exposure to hydrocodone (measured by Cmax and AUC) was not significantly affected by alcohol concentrations of 4%, 20%, and 40% compared to water. This indicates that the abuse-deterrent formulation effectively prevents rapid release of the drug even in the presence of alcohol.
Safety and Adverse Events
Despite the pharmacokinetic stability, the presence of alcohol did increase the incidence of adverse events. Higher alcohol concentrations were associated with more frequent adverse effects, highlighting the importance of caution when consuming alcohol while on hydrocodone ER .
Food and Alcohol Effects on Hydrocodone Bioavailability
Food Interaction
The bioavailability of hydrocodone ER is not significantly affected by food. A study comparing the pharmacokinetics of hydrocodone ER in fed and fasted states found no clinically significant differences in systemic exposure, Cmax, or tmax. This suggests that hydrocodone ER can be taken with or without food without impacting its effectiveness.
Alcohol Interaction
When hydrocodone ER was administered with 20% alcohol, there were no significant changes in systemic exposure or Cmax compared to administration with 0% alcohol. However, 40% alcohol significantly increased both AUC and Cmax, indicating higher systemic exposure and faster absorption of hydrocodone. This underscores the risk of increased drug effects and potential toxicity with higher alcohol concentrations.
Polysubstance Use and Hydrocodone
Combined Use with Other Substances
The concurrent use of hydrocodone with other substances, such as benzodiazepines and muscle relaxants, can potentiate its effects and increase the risk of respiratory depression. The "Houston Cocktail," a combination of hydrocodone, alprazolam, and carisoprodol, has been associated with significant impairment and increased risk of driving under the influence (DUI) incidents. This combination can lead to severe impairment in motor skills and cognitive functions, posing a substantial public safety risk.
Alcohol and Polysubstance-Related Deaths
In drug-related deaths, the presence of alcohol and other substances can significantly alter opioid concentrations. For instance, alcohol concentrations of 0.08% or higher were associated with reduced blood concentrations of hydrocodone, suggesting complex interactions that may affect the drug's pharmacokinetics and toxicity. This highlights the enhanced risks of polysubstance use involving hydrocodone and alcohol.
Ethanol and Opioid Tolerance
Reversal of Opioid Tolerance by Ethanol
Ethanol has been shown to reverse tolerance to the antinociceptive effects of opioids like hydrocodone. In animal studies, ethanol administration significantly reversed tolerance to hydrocodone without altering its brain concentrations, indicating a neuronal mechanism rather than a metabolic one. This finding suggests that ethanol can potentiate the effects of hydrocodone in tolerant individuals, potentially leading to overdose.
Conclusion
The interaction between hydrocodone and alcohol presents significant risks, including increased adverse events and potential for overdose. While hydrocodone ER formulations are resistant to dose dumping, higher alcohol concentrations can still enhance systemic exposure and adverse effects. The combined use of hydrocodone with other substances, particularly alcohol, poses serious public health and safety risks. Caution is advised when consuming alcohol while on hydrocodone therapy, and polysubstance use should be strictly avoided to prevent severe impairment and potential fatalities.
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