What are the effects of taking oxycodone, prochlorperazine, waiting 30 minutes and then taking dextromethorphan and probenecid while consuming alcohol?

Dangerous Combination of Oxycodone, Prochlorperazine, Dextromethorphan, Probenecid, and Alcohol

Taking oxycodone, prochlorperazine, dextromethorphan, and probenecid while consuming alcohol creates an extremely dangerous combination that significantly increases the risk of fatal respiratory depression and death, and should be absolutely avoided. 1, 2

Mechanisms of Dangerous Interactions

Central Nervous System Depression

• Oxycodone is a potent opioid that causes respiratory depression by activating mu-opioid receptors in the brainstem 1
• Alcohol significantly enhances oxycodone-induced respiratory depression:
  • Research shows alcohol combined with oxycodone causes a further 19% decrease in respiratory function beyond oxycodone alone 3
  • Increases the number of apneic events (breathing pauses) 3
  • Elderly individuals are particularly vulnerable to this interaction 3

Multiple Drug Interactions

• Prochlorperazine (an antiemetic/antipsychotic) can cause sedation and extrapyramidal symptoms 4
• Dextromethorphan (a cough suppressant) has additional CNS depressant effects
• Probenecid can interfere with the metabolism of other drugs, potentially increasing their blood levels and effects

Specific Risks

1. Respiratory Depression

   • The CDC explicitly warns that opioids taken with alcohol significantly increase the risk for potentially fatal respiratory depression 1
   • This risk is dose-dependent and increases with higher blood alcohol levels 1

2. Sedation and Impaired Consciousness

   • Profound sedation leading to coma may occur with this combination 2
   • Impaired consciousness increases risk of aspiration and injury

3. Cardiovascular Effects

   • Hypotension (low blood pressure)
   • Circulatory shock
   • Cardiac dysrhythmias 1

4. Pharmacokinetic Interactions

   • Alcohol can interfere with the metabolism of medications in the liver 5
   • Probenecid inhibits renal excretion of many drugs, potentially increasing their blood levels

High-Risk Populations

Certain individuals are at even higher risk with this combination:

• Elderly patients (more pronounced respiratory depression) 3
• Those with pre-existing respiratory conditions
• Patients with liver or kidney dysfunction
• Individuals with sleep apnea 1

Clinical Recommendations

1. Complete Avoidance

   • The FDA explicitly warns against combining opioids like oxycodone with alcohol 2
   • This warning extends to other CNS depressants including antiemetics like prochlorperazine

2. If Exposure Occurs

   • Immediate medical attention is required
   • Naloxone should be available to reverse opioid-induced respiratory depression 1
   • Supportive care including airway management may be necessary

3. Patient Education

   • Healthcare providers should clearly communicate these dangers to patients prescribed oxycodone 1
   • Patients should be warned about the risks of adding over-the-counter medications like dextromethorphan to prescription regimens

Alternative Approaches

For patients requiring antiemetic therapy with opioids:

• Consider alternatives to prochlorperazine with fewer CNS depressant effects
• Atypical antipsychotics like perospirone have shown similar antiemetic efficacy with fewer extrapyramidal symptoms 4

For patients with substance use concerns:

• Screening for alcohol use should be performed before prescribing opioids
• Medication-assisted treatment should be offered for patients with opioid use disorder 1

This combination represents a serious, potentially life-threatening risk that should be completely avoided in all circumstances.