Opioid Toxicity Following Concomitant Use of Macrolide Antibiotics with Fentanyl, Hydromorphone, or Oxycodone: A Population-Based Study.

CYP3A4 inhibition by macrolides (clarithromycin, erythromycin) increasing fentanyl, hydromorphone, and oxycodone concentrations

This population-based cohort study in Ontario analyzes opioid toxicity risk when CYP3A4-inhibiting macrolides (clarithromycin or erythromycin) are co-prescribed with transdermal fentanyl, hydromorphone, or oxycodone. CYP3A4 inhibition increases opioid plasma concentrations and overdose risk. Three nested case-control studies quantify the real-world clinical impact of these interactions.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

CYP3A4/opioid interactions are well-known theoretically but underestimated in practice. This large population-based study quantifies the real risk and highlights the need for prescriber alerts when co-prescribing macrolides in opioid patients — a frequent scenario in general practice.

Clinical impact: 2/3 · Evidence strength: 3/3 · Novelty: 1/2 · Sample size: 1/1 · Publication status: 1/1 → Total: 8/10