Is it safe to take Percoset (oxycodone and acetaminophen) 5mg with passion flower 700mg?

Safety of Combining Percocet 5mg with Passion Flower 700mg

Combining Percocet (oxycodone/acetaminophen) with passion flower 700mg carries potential risks due to additive central nervous system depression and possible opioid receptor interactions, and should be approached with caution.

Mechanism of Concern

Passion flower has documented effects on both GABAergic and opioid receptor systems, which creates a theoretical risk when combined with opioid analgesics like Percocet. 1

• Passion flower (Passiflora incarnata) demonstrates anticonvulsant and sedative effects that are mediated through both benzodiazepine receptors and opioid receptors 1
• In animal studies, the effects of passion flower extract were blocked by both flumazenil (a benzodiazepine antagonist) and naloxone (an opioid antagonist), confirming its activity at opioid receptors 1
• This dual mechanism suggests passion flower could potentially enhance or interfere with opioid analgesia through direct opioid receptor interaction 1

Central Nervous System Depression Risk

The primary safety concern is additive CNS depression, as both agents cause sedation through overlapping but distinct mechanisms.

• Passion flower has well-documented sedative and anxiolytic effects in human studies, with efficacy comparable to oxazepam (a benzodiazepine) for generalized anxiety disorder 2
• Percocet contains oxycodone, a Schedule II opioid that causes dose-dependent sedation, respiratory depression, and cognitive impairment 3
• The combination may result in excessive sedation, impaired coordination, and potentially respiratory depression, particularly at higher doses

Acetaminophen Considerations

Monitor total acetaminophen intake carefully, as Percocet 5mg contains 325mg of acetaminophen per tablet.

• The FDA and multiple guidelines recommend limiting total daily acetaminophen to 3,000-4,000mg to prevent hepatotoxicity 3
• Chronic acetaminophen administration should be limited to 3g or less per day 3
• Patients must avoid other acetaminophen-containing products when taking Percocet to prevent accidental overdose 4

Clinical Recommendations

If this combination is used, implement the following precautions:

• Start with the lowest effective dose of Percocet and monitor closely for excessive sedation or respiratory depression
• Avoid activities requiring alertness (driving, operating machinery) until the combined effects are known 2
• Consider using passion flower at lower doses initially (studies used 45 drops/day or approximately 300-400mg) rather than 700mg 2, 5
• Monitor for signs of opioid potentiation or antagonism, as the opioid receptor activity of passion flower could theoretically alter opioid efficacy 1

Alternative Approaches

Consider safer multimodal analgesia strategies that avoid this interaction:

• Use acetaminophen alone (up to 3g daily) with passion flower if opioids can be avoided 3
• Consider NSAIDs as an alternative to opioids for inflammatory pain, though with appropriate monitoring for GI, renal, and cardiovascular risks 3
• Non-pharmacologic interventions including physical therapy and cognitive-behavioral approaches can reduce opioid requirements 3

Key Pitfalls to Avoid

• Do not assume passion flower is "just a supplement" without pharmacologic activity - it has documented effects on opioid and GABA receptors 1
• Do not combine with alcohol or other CNS depressants, as this further increases sedation and respiratory depression risk
• Do not use long-term without reassessing opioid necessity, as guidelines recommend opioids only for severe pain not controlled by non-opioid analgesics 3
• Do not ignore signs of excessive sedation - this may indicate dangerous CNS depression requiring dose reduction or discontinuation