Oxycodone and alcohol
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The Interaction Between Oxycodone and Alcohol: Implications and Effects
Introduction to Oxycodone and Alcohol Interaction
Oxycodone, a potent opioid analgesic, is frequently prescribed for pain management but is also known for its potential for abuse. Alcohol, a central nervous system depressant, is often consumed recreationally. The combination of these two substances can have significant implications for both pharmacokinetics and pharmacodynamics, affecting their efficacy and safety profiles.
Effects on Driving Performance
Simulated Driving and Combined Substance Use
Research has shown that while oxycodone alone at therapeutic doses (5-10 mg) does not significantly impair driving performance, it does increase subjective feelings of sedation and impairment, which are not conducive to safe driving behavior1. Alcohol alone, however, does impair driving performance, particularly in terms of lateral control1. When combined, oxycodone does not exacerbate the driving impairments caused by alcohol, but the subjective effects of sedation and impairment are still present, indicating a potential risk for drivers who consume both substances1.
Pharmacokinetics and Bioavailability
Alcohol-Induced Dose Dumping
Studies have investigated the impact of alcohol on the bioavailability of oxycodone from different formulations. It was found that while a high concentration of alcohol (40%) slightly increased the overall absorption of oxycodone from once-daily formulations, it did not lead to a significant increase in peak absorption, indicating no evidence of alcohol-induced dose dumping2. This suggests that while alcohol can affect the pharmacokinetics of oxycodone, the risk of sudden, high-dose exposure remains low with certain formulations.
Subjective and Psychomotor Effects
Combined Effects on Abuse Liability
The combination of oxycodone and ethanol has been shown to increase several abuse liability-related subjective effects, such as drug liking and pleasant bodily sensations, more than either substance alone3. This indicates a higher potential for abuse when both substances are used together. However, psychomotor and cognitive performance were not significantly affected by the combination, suggesting that the primary risk lies in the subjective experience rather than overt impairment3.
Influence of Drinking Status and Sex
The effects of oxycodone can vary based on an individual's alcohol-drinking status and sex. While drinking status did not significantly modulate the effects of oxycodone, females reported more and larger unpleasant effects compared to males, such as increased nausea4. This highlights the importance of considering individual differences when assessing the risks associated with oxycodone and alcohol use.
Neurobiological and Behavioral Implications
Motivation and Neural Activation
In animal studies, co-consumption of oxycodone and alcohol influenced the intake and demand for each substance differently between sexes. Female rats showed decreased demand elasticity for oxycodone and increased cue-primed reinstatement of oxycodone-seeking behavior, while male rats did not exhibit these changes5. This suggests that alcohol can alter the motivation to seek oxycodone in a sex-dependent manner and affect the neural circuitry involved in drug-seeking behavior.
Cognitive and Side Effects in Older Adults
Impact of Alcohol Consumption Patterns
In older adults, unhealthy levels of alcohol consumption can attenuate the cognitive and side effect responses to oxycodone. Heavy alcohol consumers showed less decline in sustained attention and working memory but more decline in balance compared to healthy drinkers6. This indicates that alcohol consumption patterns should be considered when prescribing opioids to older adults, as they can influence the drug's effects.
Conclusion
The interaction between oxycodone and alcohol presents significant risks and implications for both pharmacokinetics and pharmacodynamics. While therapeutic doses of oxycodone alone may not impair driving performance, the combination with alcohol increases subjective impairment and abuse liability. Individual factors such as sex and drinking status further modulate these effects, highlighting the need for personalized approaches in managing patients who may consume both substances. Understanding these interactions is crucial for minimizing risks and ensuring safe use of oxycodone in the presence of alcohol.
Sources and full results
Most relevant research papers on this topic
Acute administration of oxycodone, alcohol, and their combination on simulated driving—preliminary outcomes in healthy adults
Acute doses of oxycodone (5, 10 mg) do not significantly impair driving performance in simulated models, but 10 mg oxycodone increases self-reported outcomes that are not compatible with safe driving behavior.
RCT
Very Rigorous JournalOnce‐Daily Oxycodone Prolonged‐Release Tablets Are Resistant to Alcohol‐Induced Dose Dumping: Results From a Randomized Trial in Healthy Volunteers
Alcohol-induced dose dumping was not observed in once-daily oxycodone prolonged-release tablets, suggesting no need to avoid alcohol while taking opioids.
RCT
Rigorous JournalSubjective, psychomotor, and physiological effects of oxycodone alone and in combination with ethanol in healthy volunteers
Oxycodone combined with a low dose of ethanol can generate abuse liability-related effects, but these effects are not increased when tested separately.
RCTRigorous JournalPsychopharmacological effects of oxycodone in healthy volunteers: roles of alcohol-drinking status and sex.
Sex differences in oxycodone's effects were observed, with females reporting more unpleasant effects than males, but alcohol-drinking status did not affect these effects.
RCTVoluntary alcohol intake alters the motivation to seek intravenous oxycodone and neuronal activation during the reinstatement of oxycodone and sucrose seeking
Alcohol consumption alters the motivation to seek oxycodone in a sex-dependent manner and alters the neural circuitry involved in cue-primed reinstatement of sucrose and oxycodone-seeking.
Non-RCT
Animal Study
PreprintCOGNITIVE AND SUBJECTIVE EFFECTS OF OXYCODONE IN OLDER ADULTS WITH HEALTHY AND UNHEALTHY ALCOHOL PATTERNS
Unhealthy alcohol consumption reduces the impact of opioid medication on cognitive performance and side effects in older adults.
Non-RCTRigorous JournalModel‐Based Analysis of the Influence of Alcohol Use and Age on Pharmacokinetics‐Pharmacodynamics of Oral Oxycodone in Middle‐Age and Older Community‐Dwelling Adults
Age and body weight influence oxycodone clearance and distribution volume, but alcohol consumption does not alter pharmacokinetics, and pupillometry pharmacodynamics is not affected by alcohol or age.
Non-RCTRigorous JournalOxycodone‐induced tolerance to respiratory depression: reversal by ethanol, pregabalin and protein kinase C inhibition
Ethanol and pregabalin can reverse oxycodone-induced tolerance to respiratory depression, potentially reducing opioid overdose deaths.
Rigorous JournalOxycodone involvement in drug abuse deaths: a DAWN-based classification scheme applied to an oxycodone postmortem database containing over 1000 cases.
Oxycodone involvement in drug abuse deaths is common, with most cases involving multiple drugs and multiple drug combinations.
Observational Study
Highly CitedEthanol Reversal of Oxycodone Tolerance in Dorsal Root Ganglia Neurons
Ethanol or a PKC inhibitor can reverse oxycodone tolerance in isolated dorsal root ganglia neurons, suggesting cellular mechanisms in reversing tolerance.
Non-RCTAnimal Study