Drug General Information (ID: DDISE9YO8N)
Drug Name			Tryptophan		Drug Info		Hydromorphone		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Analgesics
Structure

Mechanism of Tryptophan-Hydromorphone Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Tryptophan				Hydromorphone
Mechanism 1		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Tryptophan and Hydromorphone
Additive serotonergic effects Click to Show/Hide Mechanism Graph
Drug Name		Tryptophan				Hydromorphone
Mechanism 2		Serotonergic effects				Serotonergic effects
Key Mechanism Factor 2
		Factor Name		Serotonergic effects
		Factor Description		Serotonergic drugs include a variety of drugs that enhance or mimic the effects of the neurotransmitter serotonin. Excessive serotonergic activation may lead to a condition known as serotonin syndrome, in which high levels of serotonin in the brain cause the following symptoms: changes in blood pressure, coma, fever, increased heart rate, hallucinations, nausea, and seizures.
Mechanism Description		Additive serotonergic effects by the combination of Tryptophan and Hydromorphone

Recommended Action
Management		Caution is advised when opioids are used concomitantly with serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), other antidepressants/psychotropic agents (e.g., amoxapine, buspirone, lithium, maprotiline, mirtazepine, nefazodone, trazodone, vilazodone), 5-HT1 receptor agonists (triptans), 5-HT3 receptor antagonists, cyclobenzaprine, dextromethorphan, 5-hydroxytryptophan, and St. John's wort. Patients should be monitored for symptoms of the serotonin syndrome during treatment. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary.

References
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