St. John’s wort may reduce oxycodone (oxycontin, oxy-IR, etc.) levels by 50%.
St John’s wort greatly reduces the concentrations of oral oxycodone
Tuija H. Nieminen a,*, Nora M. Hagelberg a, Teijo I. Saari a, Mikko Neuvonen b, Kari Laine c,
Pertti J. Neuvonen b, Klaus T. Olkkola
European Journal of Pain xxx (2010) xxx–xxx (in press) abstract
“CONCLUSIONS: St John’s wort greatly reduced the plasma concentrations of oral oxycodone. The self-reported drug effect of oxycodone decreased significantly. This interaction may potentially be of some clinical significance when treating patients with chronic pain.”
Comment – Oxycodone got hit it December by indications that there have been “statistically” more deaths in Ontario with people prescribed oxycodones:
CMAJ. 2009 Dec 8;181(12):891-6. Epub 2009 Dec 7.
Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone.
Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN. free article here
“Opioid-related deaths in Ontario have increased markedly since 1991. A significant portion of the
increase was associated with the addition of long-acting oxycodone to the provincial drug formulary. Most of the deaths were deemed unintentional. The frequency of visits to a physician and prescriptions for opioids in the month before death suggests a missed opportunity for prevention.”
What appearred worrisome was particularly the combination of oxycodone and sedatives ( or self administered alcoholic sedation).
Comment – I have used oxycodone long acting particularly in patients I am concerned might not realize the long acting forms can take 4+ hours to kick in. (I had one dumb husband confuse long and short acting morphines when his wife had a compression fracture – kept giving long acting each hour when effect did not materialize. Wife did OK after a stint in ICU but opened my eyes to that eventuality. Even long acting oxycodones kick in after 1 hour or so. I give each of my chronic opioid users (yes any opioid) a copy of that CMAJ journal article. None seem concerned as they are on a stable dose; they are however forwarded if they drink or start on any sedatives…
Addendum – having said that, Fentanyl patch warnings continue as they should not be used in opioid niave patients – and start low and work up. I always tell the patient who starts that the initial dose is to check tolerance, not help pain – otherwise they will come back and say the stuff doesn’t work
Here is a recent fentanyl patch caution:
Am J Forensic Med Pathol. 2010 Mar;31(1):18-21.
Deaths with transdermal fentanyl patches.
Jumbelic MI. abstract here
“use of only a single transdermal patch taken as prescribed for the first time can prove fatal.”
Addendum – that article on oxycodone opioid deaths has taken a lot of flak. – Read here