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Joshua Schwimmer, MD, FACP, FASNTechnology in Medicine
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Heath Ledger's Drug Interactions

Joshua Schwimmer, MD, FACP, FASN

According to the Chief Medical Examiner of New York, Heath Ledger "died as the result of acute intoxication by the combined effects of oxycodone (Percocet), hydrocodone (Vicodin), diazepam (Valium), temazepam (Restoril), alprazolam (Xanax), and doxylamine (Unisom)."

To illustrate why he died, the following is a list of potential drug interactions from Epocrates, an online drug database:

1. diazepam <-> oxycodone
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

2. diazepam <-> temazepam
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

3. diazepam <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

4. diazepam <-> Xanax
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

5. oxycodone <-> temazepam
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

6. oxycodone <-> Vicodin
caution advised, consider dose reduction: combo may incr. risk of CNS and resp. depression, profound sedation, hypotension, other adverse effects (additive effects)

7. oxycodone <-> Xanax
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

8. temazepam <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

9. temazepam <-> Xanax
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

10. Vicodin <-> Xanax
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

(Also posted on Kidney Notes.)

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