Cns Depressants
Severe
Textbook
Increased fatalities.
Avoid combination.
Source: G&G 14e
Drug reference
heroin
Prodrug (to 6-monoacetylmorphine and morphine) · Analgesic (illicit use)
Prodrug (to 6-monoacetylmorphine and morphine)Analgesic (illicit use)
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
1 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 2 →
- Cns DepressantsSevereTextbookG&G 14e
Mechanism
Heroin (diacetylmorphine) is rapidly hydrolyzed to 6-monoacetylmorphine (6-MAM), which is then hydrolyzed to morphine. Heroin and 6-MAM are more lipid soluble than morphine, allowing faster entry into the brain. Morphine then acts as a mu-opioid receptor agonist.
Indications
Not listed as a therapeutic indication in the context of this chapter, but implicitly 'analgesia' due to conversion to morphine.
Pharmacokinetics
Metabolism
Rapidly hydrolyzed to 6-monoacetylmorphine (6-MAM), then to morphine
Excretion
Mainly in the urine, largely as free and conjugated morphine
Contraindications
- Combined with CNS depressants
Side effects
Common
sedative (less prominent than morphine)emetic (less prominent than morphine)hypotensive (less prominent than morphine)
Serious
- Respiratory depression
- Increased fatalities when combined with CNS depressants
- Pulmonary infections (especially tuberculosis)
- Bacterial infections
- Skin abscesses
- Endocarditis
- Viral infections (Hepatitis C, AIDS)
- more euphoriant (especially on i.v. injection)
- highly addicting
Drug interactions
Cocaine
Moderate
Textbook
Improved euphoria; reduction of negative side effects from each substance.
Not explicitly stated as this is a combination of illicit drugs.
Source: G&G 14e
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Ask House about heroin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team