Embeda is a combination of morphine and naltrexone that is used to control long-term pain in patients who have an inadequate response to other analgesics.
Morphine and naltrexone Uses:
-
Pain management:
- Controlling pain that is severe enough to require long-term, daily opioid medication and for which there are no effective other treatments.
- Restrictions on use: Use morphine/naltrexone ER only in individuals for whom other treatment choices (such as immediate-release opioids and non-opioid analgesics) are ineffective, poorly tolerated, or would otherwise fall short of providing appropriate pain management. It is not advised to use morphine/naltrexone ER as a stand-alone painkiller.
Morphine and naltrexone Dose in Adults:
Note:
- These are only recommendations; they do not represent the doses that may be required for each patient.
- Adapt the course of treatment in light of the patient's prior tolerance for and experience with analgesic medication.
- Only individuals who are opioid-tolerant should use morphine 100 mg/naltrexone 4 mg, a single dose > morphine 60 mg/naltrexone 2.4 mg, or a day total dose > morphine 120 mg/naltrexone 5 mg.
Morphine and Naltrexone (Embeda) Dose in the management of Pain:
-
Oral: Opiate-naive (use as the first opioid analgesic or use in patients who are not opioid-tolerant):
Note: Opioid tolerance is defined as:
- Patients who had previously taken at least 25 mcg of transdermal fentanyl every hour, at least 30 mg of oral oxycodone every day, at least 8 mg of oral hydromorphone every day, at least 25 mg of oral oxycodone every day, at least 60 mg of oral morphine every day, or at least an equivalent dose of another opioid for at least a week.
-
- Initial: 20 mg of morphine and 0.8 mg of naltrexone once daily.
Titration: You can change your dosage every one to two days. An immediate-release analgesic rescue medicine may be necessary for severe pain. If a once-daily dose is insufficient, you can upgrade to a twice-daily dose. - Conversion: Any instantaneous release opioid drug may be taken last, followed by the first dose of morphine/naltrexone ER.
- Initial: 20 mg of morphine and 0.8 mg of naltrexone once daily.
-
Conversion from other oral morphine products to morphine/naltrexone ER:
- Give the patient 50% of their daily recommended oral morphine dose as morphine/naltrexone ER every 12 hours or their entire daily recommended oral morphine dose as morphine/naltrexone ER once every day.
-
Conversion from other opioids to morphine/naltrexone ER:
- Once treatment has begun, all additional 24/7 opioids must be stopped.
There is no known conversion ratio from other opioids to morphine/naltrexone ER; keep in mind the following general considerations and give patients breakthrough pain relief with rescue medication. Starting dose: morphine 30 mg/naltrexone 1.2 mg once day (e.g., immediate-release morphine).
- Once treatment has begun, all additional 24/7 opioids must be stopped.
-
Conversion from parenteral to oral morphine:
- To achieve the same level of pain relief as 1 mg of parenteral morphine, it might take 2 to 6 mg of oral morphine. Three times the daily parenteral dose given orally may be sufficient.
-
Conversion from other (non-morphine) oral/parenteral opioids to oral morphine:
- There are no precise recommendations; instead, refer to the relative potency data that has been shared while keeping in mind that these ratios are simply estimates.
- Giving 50% of the predicted daily morphine requirement as the initial dose and treating insufficient relief with immediate-release morphine is typically the safest course of action.
-
Conversion from methadone to morphine/naltrexone ER:
- When transitioning methadone to another opioid, strict monitoring is required.
Based on earlier dose exposure, the ratio of methadone to other opioid agonists varies considerably. Methadone can build up in the plasma and has a long half-life.
- When transitioning methadone to another opioid, strict monitoring is required.
Discontinuation of therapy:
- When suspending therapy, conduct a continuous downward titration. For example, in a physically dependent patient, reduce the dose by no more than 10% to 25% and keep doing so every 2 to 4 weeks.
- If the patient has withdrawal symptoms, briefly stop the taper, or raise the dose to the level of the prior dose before reducing the dose more gradually by lengthening the time between dose reductions, lowering the daily dose reduction, or both.
-
Dosage adjustment for concomitant therapy:
- When taking other CNS depressants, start the morphine/naltrexone ER combination at 33% to 50% of the recommended starting dose.
Embeda Use in Children:
Not indicated.
Embeda Pregnancy Risk Category: C
- [US Boxed Warning]If opioids are used for long periods of time during pregnancy, it can lead to newborn withdrawal syndrome.
- This condition can be fatal if not treated according the protocols established by neonatology specialists.
- Prevent the use of opioids for prolonged periods in pregnant women.
- This will ensure that the proper treatment is available.
- The withdrawal may be precipitated by the naltrexone ingredient.
- For more information, refer to the individual monographs.
Use during breastfeeding:
- Breast milk contains naltrexone and morphine.
- The manufacturer does not recommend breastfeeding due to the risk of adverse reactions in nursing infants.
- Refer to the individual monographs.
Embeda Dose in Kidney Disease:
No exact dosage adjustments are given in the manufacturer's labeling; begin with a lower than usual dosage and titrate slowly.
Embeda Dose in Liver disease:
No exact dosage adjustments are given in the manufacturer's labeling; begin with a lower than usual dosage and titrate slowly.
Side effects of Morphine and Naltrexone (Embeda):
-
Cardiovascular:
- Flushing
- Peripheral Edema
-
Central Nervous System:
- Drowsiness
- Dizziness
- Headache
- Fatigue
- Insomnia
- Anxiety
- Chills
- Depression
- Irritability
- Lethargy
- Restlessness
- Sedation
-
Dermatologic:
- Pruritus
- Hyperhidrosis
-
Endocrine & Metabolic:
- Hot Flash
-
Gastrointestinal:
- Constipation
- Nausea
- Vomiting
- Xerostomia
- Abdominal Pain
- Anorexia
- Decreased Appetite
- Dyspepsia
- Flatulence
-
Neuromuscular & Skeletal:
- Arthralgia
- Muscle Spasm
- Tremor
Contraindications to Morphine and Naltrexone (Embeda):
- Sensitivity to morphine, Naltrexone, or any other formulation ingredient
- Any type of respiratory depression is a dangerous disorder.
- severe bronchial asthma without equipment for observation or resuscitation.
- Use of monoamine-oxidase inhibitors (MAOIs) or concurrent use within the previous two weeks; paralytic ileus; GI blockage (known or suspected).
- It is difficult to document cross-reactivity between opioids and allergenic substances. Cross-sensitivity is possible due to similarities in chemical compositions and/or pharmacologic reactions. However, this cannot be ruled out.
Warnings and precautions
-
CNS depression:
- CNS depression can cause mental or physical impairments.
- Patients should be aware that driving or operating machinery requires mental attention.
-
Constipation
- Constipation can be a problem in patients with unstable angina or post-myocardial injury patients.
-
Hypotension
- It can cause severe hypotension, including orthostatic hypotension, syncope, and heart disease.
- Patients with hypovolemia, cardiac disease (including acute MI), or drugs that increase hypotensive effects (e.g. phenothiazines, general anesthetics) should be cautious.
- After dose titration or initiation, be aware of signs and symptoms that could indicate hypotension.
- Patients with circulatory shock should not use this product.
-
Phenanthrene hypersensitivity:
- Patients with hypersensitivity reactions to other opioid agonists phenanthrene derivatives (codeine or hydrocodone or hydromorphone, levorphanol oxycodone or oxymorphone) should use Up with caution
-
Respiratory depression [US Boxed Warning]
- It is possible to develop life-threatening or fatal respiratory depression.
- Monitor your respiratory health closely, especially during dose increases or introductions.
- You can either swallow the whole capsules or sprinkle the contents on applesauce.
- The fast release of morphine/naltrexone ER may be caused by crushing, chewing, and dissolving the pellets.
- The sedating effects that opioid-induced respiratory depression can cause carbon dioxide retention may be exacerbated by opioids.
-
Conditions abdominales:
- Patients with acute abdominal conditions may not be diagnosed or treated appropriately.
-
Adrenocortical Insufficiency
- Patients with adrenal insufficiency (Addison disease) should exercise caution.
- Extended opioid use can lead to secondary hypogonadism.
- This could cause infertility, sexual dysfunction, mood disorders, and osteoporosis.
-
Insufficiency of the biliary tract:
- Patients with biliary dysfunction or acute pancreatitis should be cautious. Opioids can cause constriction to the sphincter.
-
CNS depression/coma:
- Patients with CNS impairment consciousness or coma should not use this medication.
- These patients are more susceptible to the intracranial effects CO2 retention.
-
Delirium tremens:
- Patients with delirium-tremens should be supervised.
-
Head trauma
- Patients with intracranial lesions or a head injury should be used with caution. An increase in intracranial pressure may occur from opioid treatment.
-
Hepatic impairment
- Patients with hepatic impairment should use with caution.
-
Mental health conditions
- Patients with mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorder (e.g., PTSD) should be prescribed opioids with restraint to manage persistent pain.
- This is because of the increased risk of opioid overdose and opioid use disorder. It is best to have more frequent monitoring.
-
Obesity:
- Patients who are morbidly obese should be used with caution.
-
Prostatic hyperplasia, urinary stricture
- Patients with prostatic hyperplasia or urinary stricture should use caution.
-
Psychosis:
- Patients with toxic psychosis should be treated with caution.
-
Renal impairment
- Patients with severe renal impairment should be used with caution
-
Respiratory disease
- Patients with severe obstructive or persistent lung disease, cor pulmonale or significant lung damage should be watched for signs of respiratory depression.
- This is especially important when starting therapy or titrating treatment.
- Consider the possibility of using nonopioid substitute analgesics for these patients.
-
Seizure disorders:
- Patients with seizure disorders may be subject to restraint. This could possibly cause or aggravate seizures.
-
Sleep-related disorders
- In a dose-dependent manner, opioid use can increase the risk of sleep-related disorders such as central sleep apnea [CSA], and hypoxemia.
- Patients with sleep-disordered or heart disease (e.g. obesity, heart failure) should be vigilant in avoiding prolonged pain.
- Consider reducing the dose for patients suffering from central sleep apnea.
- Patients with mild to severe sleep-disordered breath should not take opioids.
-
Thyroid dysfunction:
- Patients with thyroid dysfunction should exercise caution.
Morphine and naltrexone: Drug Interaction
|
Alfuzosin |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Amphetamines |
May enhance the analgesic effect of Opioid Agonists. |
|
Anticholinergic Agents |
May enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. |
|
Blood Pressure Lowering Agents |
May enhance the hypotensive effect of HypotensionAssociated Agents. |
|
Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Brimonidine (Topical) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Desmopressin |
Opioid Agonists may enhance the adverse/toxic effect of Desmopressin. |
|
Diazoxide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dimethindene (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Diuretics |
Opioid Agonists may enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Dronabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
DULoxetine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. |
|
Erdafitinib |
May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. |
|
Esmolol |
Morphine (Systemic) may increase the serum concentration of Esmolol. |
|
Gabapentin |
May enhance the CNS depressant effect of Morphine (Systemic). Morphine (Systemic) may increase the serum concentration of Gabapentin. |
|
Gastrointestinal Agents (Prokinetic) |
Opioid Agonists may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). |
|
Herbs (Hypotensive Properties) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Hypotension-Associated Agents |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. |
|
Kava Kava |
May enhance the adverse/toxic effect of CNS Depressants. |
|
Levodopa-Containing Products |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. |
|
Lofexidine |
May decrease the serum concentration of Naltrexone. |
|
Lumacaftor |
May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. Lumacaftor may increase the serum concentration of P-glycoprotein/ABCB1 Substrates. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Minocycline (Systemic) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Molsidomine |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Naftopidil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicergoline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicorandil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nitroprusside |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. |
|
Pegvisomant |
Opioid Agonists may diminish the therapeutic effect of Pegvisomant. |
|
Pentoxifylline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
P-glycoprotein/ABCB1 Inducers |
May decrease the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). |
|
P-glycoprotein/ABCB1 Inhibitors |
May increase the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of pglycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). |
|
Phosphodiesterase 5 Inhibitors |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
Prostacyclin Analogues |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Quinagolide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Ramosetron |
Opioid Agonists may enhance the constipating effect of Ramosetron. |
|
Ranolazine |
May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. |
|
RifAMPin |
May decrease the serum concentration of Morphine (Systemic). |
|
ROPINIRole |
CNS Depressants may enhance the sedative effect of ROPINIRole. |
|
Rotigotine |
CNS Depressants may enhance the sedative effect of Rotigotine. |
|
Rufinamide |
May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. |
|
Selective Serotonin Reuptake Inhibitors |
CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. |
|
Serotonergic Agents (High Risk |
Opioid Agonists may enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. |
|
Succinylcholine |
May enhance the bradycardic effect of Opioid Agonists. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Risk Factor D (Consider therapy modification) |
|
|
Alvimopan |
Opioid Agonists may enhance the adverse/toxic effect of Alvimopan. This is most notable for patients receiving long-term (i.e., more than 7 days) opiates prior to alvimopan initiation. Management: Alvimopan is contraindicated in patients receiving therapeutic doses of opioids for more than 7 consecutive days immediately prior to alvimopan initiation. |
|
Amifostine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. |
|
Antiplatelet Agents (P2Y12 Inhibitors) |
Morphine (Systemic) may diminish the antiplatelet effect of Antiplatelet Agents (P2Y12 Inhibitors). Morphine (Systemic) may decrease the serum concentration of Antiplatelet Agents (P2Y12 Inhibitors). Management: Consider alternative antiischemic/analgesic therapies (eg, beta-blockers, nitroglycerin) in patients with acute coronary syndromes treated with a P2Y12 inhibitor when possible. The risks associated with other opioids are unknown. Exceptions: Cangrelor. |
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
|
CNS Depressants |
May enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Lemborexant |
May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. |
|
Methotrimeprazine |
CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. |
|
Nalmefene |
May diminish the therapeutic effect of Opioid Agonists. Management: Avoid the concomitant use of nalmefene and opioid agonists. Discontinue nalmefene 1 week prior to any anticipated use of opioid agonistss. If combined, larger doses of opioid agonists will likely be required. |
|
Naltrexone |
May diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. |
|
Obinutuzumab |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. |
|
Opioid Agonists |
Naltrexone may diminish the therapeutic effect of Opioid Agonists. Management: Seek therapeutic alternatives to opioids. See full drug interaction monograph for detailed recommendations. |
|
OxyCODONE |
CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
|
Sincalide |
Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. |
|
Sodium Oxybate |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. |
|
Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
|
Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
|
Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
|
Risk Factor X (Avoid combination) |
|
|
Azelastine (Nasal) |
CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). |
|
Bremelanotide |
May lower the level of naltrexone in the serum. |
|
Bromperidol |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. |
|
Bromperidol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Eluxadoline |
Opioid Agonists may enhance the constipating effect of Eluxadoline. |
|
Lasmiditan |
May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. |
|
Methylnaltrexone |
Opioid antagonists' harmful or toxic effects might be amplified. Particularly, there may be an increased risk of opioid withdrawal. |
|
Monoamine Oxidase Inhibitors |
May intensify the negative or harmful effects of morphine (Systemic). |
|
Naldemedine |
Opioid antagonists may intensify Naldemedine's harmful or hazardous effects.Particularly, there may be an increased risk of opioid withdrawal. |
|
Naloxegol |
Opioid antagonists may intensify Naloxegol's harmful or hazardous effects. Particularly, there may be an increased risk of opioid withdrawal. |
|
Opioids (Mixed Agonist / Antagonist) |
May diminish the analgesic effect of Opioid Agonists. Management: Seek alternatives to mixed agonist/antagonist opioids in patients receiving pure opioid agonists, and monitor for symptoms of therapeutic failure/high dose requirements (or withdrawal in opioid-dependent patients) if patients receive these combinations. |
|
Orphenadrine |
CNS Depressants may enhance the CNS depressant effect of Orphenadrine. |
|
Oxomemazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Paraldehyde |
CNS Depressants may enhance the CNS depressant effect of Paraldehyde. |
|
Sibutramine |
May enhance the adverse/toxic effect of Centrally Acting Weight Loss Agents. |
|
Thalidomide |
CNS Depressants may enhance the CNS depressant effect of Thalidomide. |
Monitoring parameters:
- Treatment of pain, mental and respiratory disorders, and blood pressure
- Hypogonadism and hypoadrenalism symptoms.
- Alternate suggestions:
- Long-term pain (long-term treatment that is not end-of life or relaxing, active cancer treatment or sickle cell disease or medication-assisted opioid use disorder treatment):
- Within 1 to 4 weeks after treatment begins, and as doses increase, you can evaluate the pros and cons.
- Patients at higher risk for overdose or those with opioid addiction should have their benefits and risks reevaluated every three months.
- Before initiating any drug treatment, it is recommended that urine drug testing be done. Re-checking should also be considered at least once a year (includes prescription drugs and illegal drugs of abuse).
- Clinicians should evaluate state prescription drug monitoring program data (PDMP) before initiation and periodically throughout therapy (frequency ranging between every prescription to every three months).
- Long-term pain (long-term treatment that is not end-of life or relaxing, active cancer treatment or sickle cell disease or medication-assisted opioid use disorder treatment):
How to administer Morphine and Naltrexone (Embeda)?
- The pellets should be swallowed whole without crushing, chewing, or dissolving the pellets in the capsule when ingesting.
- You can sprinkle the capsule's contents onto applesauce (do not separate the doses) and consume it whole, without chewing.
- To ensure that all of the contents have been ingested, rinse your mouth.
- Using a gastric or nasogastric tube to give morphine/naltrexone ER pellets is not recommended.
Mechanism of action of Morphine and Naltrexone (Embeda):
Morphine:
- binds to opiate receptors in the central nervous system (CNS), inhibiting ascending pain pathways and changing how pain is perceived and handled.
Naltrexone:
- a pure opioid antagonist that, by binding competitively to mu-opioid agonists, counteracts the perceived analgesic and analgesic effects of mu-opioid agonists.
Refer to individual agents (Morphine and Naltrexone)
International Brand Names of Morphine and naltrexone:
- Embeda
Morphine and naltrexone Brand Names in Pakistan:
No Brands Available in Pakistan.
