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  • BDD Moderators: Keif’ Richards | negrogesic

Ethanol increases codeine -> morphine by 80%? CYP2D6 induction

I can vouch for the fact that yes, alcohol does potentiate codeine from personal experience. But I highly doubt it would convert 80% percent instead of the usual 10%. Think about it mate, that would mean a dose of codeine is made EIGHT times stronger with the alcohol. If this were truly the case, the government would have to write a BIG warning on either codeine products or alcohol products, possibly both cos that's almost a full 100% morphine conversion, which could be lethal for somebody who's opiate-naive. The old hypnotic drug Glutethimide (Doriden) would be the very best codeine potentiator, but extreme caution is advised for that combo as it caused a lot of codeine overdoses when it used to be prescribed.

I don't understand what is meant here by "at a concentration of 1,1%". Can somebody explain?
 
If an 80% boost in effect is being implied, then I can say empirically that this is not the case. I don't doubt that alcohol can have some effect on Codeine's metabolism, but we're talking about almost doubling it. In other instances and with other Opioids, alcohol taken in conjunction with a dose can lead to faster effects and of course more sedation, but that's just the synergy of alcohol and Opioid, not necessarily the alcohol making the Codeine stronger.
 
Alcohol inhibits CYP3A4, which is responsible for N-demethylating codeine into the inactive norcodeine, so to that effect it just slows the irreversible deactivation of codeine (leaving more room for O-demethylation by CYP2D6, which is what we want).

The article states

Ethanol showed a biphasic effect on CYP2D6 metabolism, increasing initially the CYP2D6 activity with 175% of control up to a concentration of 1.1%, where after ethanol linearly inhibited the CYP2D6 activity.

It does seem like they imply a 1.75 times increase in CYP2D6 activity, however I'm not sure that it translates to 1.75 more morphine, but it's still a significant increase.

However, I'm a heavy codeine user - 1000 mg once a day, every day for the last half a year. I have drunk a little and a lot of alcohol before taking codeine, and I can't even tell for sure if it pharmacologically potentiates it (hard to tell if you're smashed). There is certainly depressant potentiation - which is obvious if you mix 2 downers. But I definitely didn't feel a doubling in codeine effect, which would be drastic at my 1000 mg dose.

E: reading more of the article, it appears that the best induction of 2D6 happened at 1.1% ethanol concentration, and at 0.1% concentration there was no significant increase. Since codeine metabolism happens in the liver, it would mean that to get the best results you'd have to have 1.1% ethanol concentration in the liver cells, which would require at least 1.1% in the blood I guess. I don't think anyone would be conscious to notice any potentiation at that BAC. According to their graph, you'd need at least something like 0.25-0.3% to get a significant effect, but at that level of intoxication you probably wouldn't notice the minimal effect. This explains why ethanol isn't effective at potentiating codeine.
 
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