Drug interactions
Benzhydrocodone / acetaminophen + Hydromorphone
Severity: Major
Benzhydrocodone / acetaminophen and Hydromorphone: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Benzhydrocodone is a prodrug of hydrocodone, so using it with hydromorphone amounts to combining two full opioid agonists. This duplicates opioid effects and can cause profound sedation, respiratory depression and death, and acetaminophen adds to total daily dose burden if other products are used.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive mu-opioid receptor agonism causing CNS and respiratory depression.
What to do
Avoid concurrent use of two full opioid agonists unless converting therapy; if overlap is unavoidable, use minimal doses and durations and monitor respiratory rate and sedation closely. Count total opioid exposure and acetaminophen intake.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Benzhydrocodone / acetaminophen with Hydromorphone?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Benzhydrocodone is a prodrug of hydrocodone, so using it with hydromorphone amounts to combining two full opioid agonists. This duplicates opioid effects and can cause profound sedation, respiratory depression and death, and acetaminophen adds to total daily dose burden if other products are used.
How serious is the interaction between Benzhydrocodone / acetaminophen and Hydromorphone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use of two full opioid agonists unless converting therapy; if overlap is unavoidable, use minimal doses and durations and monitor respiratory rate and sedation closely. Count total opioid exposure and acetaminophen intake.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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