Phenytoin Codeine

Codeine, hydrocodone, morphine, methadone, and oxycodone are substrates of the cytochrome P-450 isoenzyme CYP2D6.47 Inhibition of CYP2D6 results in decreased analgesia of codeine and hydrocodone due to decreased conversion to the active metabolites (e.g., morphine and hydromorphone, respectively) and increased effects of morphine, methadone, and oxycodone. Methadone is also a substrate of CYP3A4, and its metabolism is increased by phenytoin and decreased by cimetidine. CNS depressants may potentiate the sedative effects of opiates. 

Decreased cigarette consumption in smokers, easier to stop smoking Exaggerated response to warfarin and phenytoin Increased efficacy of omeprazole, increased toxicity of mephenytoin Absence of codeine efficacy, no effect of encainide, increased levels of tricyclic antidepressants, fluoxetine, phenothiazines Sustained paralysis to succinylcholine, possible increased toxicity of cocaine Unknown... 

Codeine Hydrochloride Dequalinium Acetate Fluorometholone Hexamethonium Bromide Riboflavine Stilbazium Iodide Mianserin Hydrochloride Tacrine Hydrochloride Diclofenac Sodium Vinblastine Sulphate Cyclizine Hydrochloride Amiloride Hydrochloride Protoveratrine B Meclofenamate Sodium 5-Methyltryptamine Hydrochloride Dicoumarol Mebendazole Pipradrol Hydrochloride Carbenoxolone Flucytosine Phanquone Phenytoin... 

A4 34.1 Acetaminophen, caffeine carbamazepine, codeine, cortisol, erythromycin, cyclophosphamide, (S)-and (R)-warfarin, phenytoin, testosterone, halothane, zidovudine... 

Column Partisil 5 urn (250x4.6 mm ID), mobile phase diethyl ether 95% saturated with water + 0.4% diethylamine, flow rate 2 ml/min, detection UV 254 nm. Peaks 1, noscapine 2, aconitine 3, papaverine 4, emetine 5, ephedrine 6, cephaeline 7, scopolamine 8, ethylmorphine 9, codeine 10, phenytoine 11 homatropine 12, N-methylephedrine 13, narceine 14, quinine ... 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

Simultaneous chlordieizepoxide, chlorpromazine, cimetidine, clomipramine, diazepam, doxepin, flurazepam, lorazepeun, oxeizepam, p>entobarbital, perphenazine, phenobarbital, phenytoin, prochlorperazine, secobarbital, thioridazine, trifluoperazine Noninterfering acetaminophen, codeine, meperidine Interfering propoxyphene... 

Wong, S.H.Y. McHugh, S.L. Dolan, J. Cohen, K.A. Tricyclic antidepressant analysis by reversed-phase liquid chromatography using phenyl columns. J.Liq.Chromatogr., 1986, 9, 2511-2538 [also acetaminophen, amobarbital, amoxapine, barbital, chlordiazepoxide, chlorpromazine, cimetidine, clomipramine, codeine, desipramine, desmethyldoxepin, diazepam, doxepin, fluphenazine, flurazepam, glutethimide, hydroxyamoxapine, imipramine, lorazepam, maprotiline, meperidine, metabolites, nortriptyline, oxazepam, pentobarbital, perphenazine, phenobarbital, phenytoin, propoxyphene, protriptyline, secobarbital, thioridazine, trazodone]... 

Extracted acetaminophen, amobarbital, butabarbital, chlordiazepoxide, diazepam, eth-chlorvynol, flurazepam, glutethimide, methaqualone, methypiylon, nitrazepam, pentobarbital, phenobarbital, phenytoin, primidone, salicgrlic acid, secobarbital, theophylline Simultaneous amitriptyline, caffeine, clomipramine, codeine, desipramine, ethotoin, imip-ramine, lidocaine, mesantoin, methsuximide, nirvanol, nortriptyline, oxazepam, procainamide, phenylpropanolamine, propranolol, quinidine... 

Noninterfering acetaminophen, acetylmorphine, amiodarone, amobarbital, amphetamine, bendroflumethiazide, benzocaine, benzoylecgonine, benzthiazide, butalbital, carbamaze-pine, chlorothiazide, clonazepam, cocaine, codeine, cotinine, cyclosporine, cyclothiazide, desalkylflurazepam, diamorphine, dicumerol, ephedrine, ethaciynic acid, ethanol, eth-chlorvynol, ethosuximide, furosemide, glutethimide, hydrochlorothiazide, hydrocodone, hydroflumethiazide, hydromorphone, lorazepam, mephentermine, meprobamate, meth-amphetamine, metharbital, methoxsalen, methoxyphenteramine, methsuximide, meth-ylcyclothiazide, metoprolol, MHPG, monoacetylmorphine, morphine, normethsuximide, oxazepam, oxycodone, oxymorphone, pentobarbital, phencyclidine, phenteramine, phenylephrine, phenytoin, polythiazide, primidone, prochlorperazine, salicylic acid, sulfanilamide, THC-COOH, theophylline, thiazolam, thiopental, thioridazine, tocainide, trichlo-romethiazide, trifluoperazine, valproic acid, warfarin... 

---