Dangerous Effects of Taking Oxycodone, Prochlorperazine, Dextromethorphan, Probenecid, and Alcohol Together
Taking oxycodone, prochlorperazine, dextromethorphan, probenecid, and alcohol together within an hour creates a potentially life-threatening combination that significantly increases the risk of respiratory depression, sedation, and death. 1, 2, 3
Respiratory Depression Risk
The combination presents severe risks to respiratory function:
Oxycodone + Alcohol: This combination alone causes profound respiratory depression. Research shows that ethanol exacerbates oxycodone-induced respiratory depression by an additional 19% beyond oxycodone's baseline 28% reduction in minute ventilation 3. This effect is even more pronounced in elderly individuals.
Multiple CNS Depressants: The FDA explicitly warns against combining opioids like oxycodone with alcohol or other CNS depressants due to the risk of severe drowsiness, decreased awareness, breathing problems, coma, and death 2.
Dextromethorphan + Alcohol: This combination can cause dissociative states and psychotic symptoms that may mask signs of respiratory depression, making the situation more dangerous 4.
Cardiovascular and Neurological Risks
This combination also poses significant cardiovascular and neurological dangers:
Hypotension: Oxycodone can cause severe hypotension, which may be worsened by alcohol and prochlorperazine 2, 1.
Sedation: All components (oxycodone, alcohol, prochlorperazine, and dextromethorphan) have sedative properties that compound each other's effects 1.
Increased Opioid Effects: Alcohol can reverse tolerance to oxycodone's respiratory depressant effects, potentially leading to overdose even in individuals who regularly use oxycodone 5.
Drug Interactions
Several specific interactions increase risk:
Probenecid: Inhibits the metabolism of many drugs and may increase blood levels of oxycodone, potentially enhancing toxicity.
Prochlorperazine: As a phenothiazine, it may enhance CNS depression when combined with opioids 1.
Dextromethorphan + Alcohol: This combination causes dissociative states that may mask symptoms of overdose and delay seeking medical attention 4.
Signs of Toxicity to Monitor
Signs of this dangerous combination include:
- Respiratory depression (fewer than 12 breaths per minute)
- Oxygen saturation below 92%
- Hypotension (systolic BP below 90 mmHg)
- Altered mental status or unconsciousness
- Apneic events (temporary cessation of breathing)
Emergency Management
If someone has taken this combination:
- Seek immediate emergency medical attention
- Naloxone administration for opioid-induced respiratory depression 1
- Airway management and ventilatory support as needed
- Continuous monitoring of vital signs, especially respiratory rate and oxygen saturation
Prevention Strategies
To prevent these dangerous interactions:
- Never combine opioids with alcohol or other CNS depressants 2
- Healthcare providers should screen for substance use before prescribing opioids 1
- Patients should be educated about the life-threatening risks of these combinations 1
- Naloxone should be made available to caregivers of patients taking opioids 1
Common Pitfalls
- Underestimating the interaction: Even small amounts of alcohol can dangerously potentiate opioid effects 3
- Masking of symptoms: The stimulant properties of dextromethorphan may temporarily mask sedation, giving a false sense of safety
- Delayed toxicity: Effects may worsen over time as all substances are metabolized at different rates
- Assuming tolerance is protective: Alcohol can reverse oxycodone tolerance, making even regular users vulnerable to overdose 5
This combination represents an extremely high-risk scenario with significant potential for fatal outcomes due to the multiple mechanisms by which these substances enhance each other's dangerous effects.