Morphine Naltrexone Brand Name– Embeda
What is Morphine Naltrexone
Morphine naltrexone is an oral combination opioid agonist and opioid antagonist indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve morphine; naltrexone for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.
Morphine naltrexone is abuse-deterrent and formulated with sequestered naltrexone.
The sequestered naltrexone in morphine; naltrexone is intended to have no clinical effect when administered as directed; however, if the capsules are crushed or chewed, up to 100% of the sequestered naltrexone could be released, which may precipitate withdrawal in the opioid-tolerant patient. Risk of overdose and death are also increased if morphine; naltrexone is cut, broken, chewed, crushed, or dissolved.
Indications
- severe pain
Side Effects
- abdominal pain
- adrenocortical insufficiency
- amenorrhea
- anaphylactoid reactions
- anorexia
- anxiety
- arthralgia
- asthenia
- blurred vision
- bradycardia
- cardiac arrest
- chills
- cholecystitis
- confusion
- constipation
- depression
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dyspnea
- dysuria
- elevated hepatic enzymes
- euphoria
- fatigue
- flatulence
- flushing
- GI obstruction
- gonadal suppression
- hallucinations
- headache
- hyperamylasemia
- hyperhidrosis
- hypertension
- hyponatremia
- hypotension
- ileus
- impotence (erectile dysfunction)
- infertility
- irritability
- lethargy
- libido decrease
- malaise
- memory impairment
- miosis
- myalgia
- nausea
- neonatal opioid withdrawal syndrome
- orthostatic hypotension
- palpitations
- pancreatitis
- paresthesias
- peripheral edema
- physiological dependence
- pruritus
- psychological dependence
- rash
- respiratory depression
- restlessness
- rhinorrhea
- serotonin syndrome
- SIADH
- sinus tachycardia
- syncope
- tolerance
- tremor
- urinary retention
- vomiting
- weakness
- withdrawal
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- abrupt discontinuation
- accidental exposure
- acute abdomen
- adrenal insufficiency
- alcoholism
- angina
- asthma
- biliary tract disease
- bladder obstruction
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- chronic obstructive pulmonary disease (COPD)
- CNS depression
- coadministration with other CNS depressants
- coma
- constipation
- cor pulmonale
- dehydration
- depression
- driving or operating machinery
- emphysema
- ethanol ingestion
- ethanol intoxication
- geriatric
- GI disease
- GI obstruction
- head trauma
- heart failure
- hepatic disease
- hypotension
- hypothyroidism
- hypovolemia
- hypoxemia
- ileus
- increased intracranial pressure
- infertility
- inflammatory bowel disease
- intracranial mass
- labor
- laboratory test interference
- MAOI therapy
- myxedema
- neonatal opioid withdrawal syndrome
- obesity
- obstetric delivery
- oliguria
- opioid overdose
- opioid use disorder
- opioid-naive patients
- orthostatic hypotension
- pancreatitis
- parenteral administration
- potential for overdose or poisoning
- pregnancy
- prostatic hypertrophy
- psychosis
- pulmonary disease
- renal failure
- reproductive risk
- requires an experienced clinician
- respiratory depression
- respiratory insufficiency
- scoliosis
- seizure disorder
- seizures
- shock
- sleep apnea
- status asthmaticus
- substance abuse
- ulcerative colitis
- urethral stricture
- urinary retention
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Tramadol
- Acrivastine; Pseudoephedrine
- Adefovir
- Aldesleukin, IL-2
- Alfentanil
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Almotriptan
- Alosetron
- Alprazolam
- Alvimopan
- Amide local anesthetics
- Amifampridine
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amobarbital
- Amoxapine
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Anticholinergics
- Apomorphine
- Apraclonidine
- Aripiprazole
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir; Cobicistat
- Atenolol; Chlorthalidone
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine
- Azelastine; Fluticasone
- Azilsartan; Chlorthalidone
- Baclofen
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzhydrocodone; Acetaminophen
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Benztropine
- Bethanechol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Boceprevir
- Brexpiprazole
- Brigatinib
- Brimonidine
- Brimonidine; Brinzolamide
- Brimonidine; Timolol
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Bumetanide
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion
- Bupropion; Naltrexone
- Buspirone
- Butabarbital
- Butorphanol
- Cabozantinib
- Candesartan; Hydrochlorothiazide, HCTZ
- Cannabidiol
- Capmatinib
- Capsaicin; Metaxalone
- Captopril; Hydrochlorothiazide, HCTZ
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Carvedilol
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chloral Hydrate
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorothiazide
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone
- Chlorthalidone; Clonidine
- Chlorzoxazone
- Cimetidine
- Citalopram
- Clemastine
- Clobazam
- Clomipramine
- Clonazepam
- Clonidine
- Clopidogrel
- Clorazepate
- Clozapine
- Cobicistat
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Conivaptan
- Crofelemer
- Cyclizine
- Cyclobenzaprine
- Cyproheptadine
- Daclatasvir
- Dantrolene
- Darifenacin
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Desflurane
- Desipramine
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmedetomidine
- Dexpanthenol
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dicyclomine
- Dienogest; Estradiol valerate
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Dolasetron
- Donepezil; Memantine
- Doxepin
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Droperidol
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Elagolix; Estradiol; Norethindrone acetate
- Eletriptan
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Eltrombopag
- Eluxadoline
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Enalapril; Hydrochlorothiazide, HCTZ
- Enflurane
- Entecavir
- Eprosartan; Hydrochlorothiazide, HCTZ
- Escitalopram
- Esketamine
- Esmolol
- Estazolam
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Eszopiclone
- Ethacrynic Acid
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethotoin
- Etomidate
- Etravirine
- Fenfluramine
- Fentanyl
- Fesoterodine
- Flavoxate
- Flibanserin
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fluvoxamine
- Fosamprenavir
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Fospropofol
- Fostamatinib
- Frovatriptan
- Furosemide
- Gabapentin
- General anesthetics
- Glecaprevir; Pibrentasvir
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Granisetron
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guanabenz
- Guanfacine
- Haloperidol
- Halothane
- Homatropine; Hydrocodone
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxyzine
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen; Oxycodone
- Iloperidone
- Imipramine
- Indacaterol; Glycopyrrolate
- Indapamide
- Isocarboxazid
- Isoflurane
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Istradefylline
- Ivacaftor
- Ixabepilone
- Ketamine
- Lapatinib
- Lasmiditan
- Ledipasvir; Sofosbuvir
- Lemborexant
- Leuprolide; Norethindrone
- Levobupivacaine
- Levocetirizine
- Levomilnacipran
- Levonorgestrel
- Lidocaine
- Lidocaine; Prilocaine
- Lincosamides
- Linezolid
- Lisdexamfetamine
- Lithium
- Lofexidine
- Loop diuretics
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lorazepam
- Lorcaserin
- Loxapine
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Lumateperone
- Lurasidone
- Magnesium Salts
- Maprotiline
- Melatonin
- Memantine
- Mepenzolate
- Meperidine; Promethazine
- Mephobarbital
- Mepivacaine
- Mepivacaine; Levonordefrin
- Meprobamate
- Mestranol; Norethindrone
- Metaxalone
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methocarbamol
- Methohexital
- Methscopolamine
- Methyclothiazide
- Methyldopa
- Methylene Blue
- Methylphenidate
- Metoclopramide
- Metolazone
- Metyrapone
- Metyrosine
- Midazolam
- Milnacipran
- Minocycline
- Mirtazapine
- Molindone
- Monoamine oxidase inhibitors
- Nabilone
- Nalbuphine
- Naloxone
- Naltrexone
- Naproxen; Sumatriptan
- Naratriptan
- Nefazodone
- Neratinib
- Nesiritide, BNP
- Nitroglycerin
- Norethindrone
- Norgestrel
- Nortriptyline
- Octreotide
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Ondansetron
- Oral Contraceptives
- Orphenadrine
- Osimertinib
- Oxazepam
- Oxybutynin
- Oxycodone
- Oxymorphone
- Ozanimod
- Paliperidone
- Palonosetron
- Papaverine
- Paroxetine
- Pegvisomant
- Pentazocine
- Pentazocine; Naloxone
- Pentobarbital
- Perampanel
- Perphenazine
- Perphenazine; Amitriptyline
- Phenelzine
- Phenobarbital
- Phenylephrine; Promethazine
- Phenytoin
- Pimozide
- Posaconazole
- Potassium-sparing diuretics
- Pramipexole
- Pramlintide
- Prasugrel
- Pregabalin
- Prilocaine
- Prilocaine; Epinephrine
- Primidone
- Procarbazine
- Prochlorperazine
- Promethazine
- Propantheline
- Propofol
- Protriptyline
- Quazepam
- Quetiapine
- Quinidine
- Ramelteon
- Rasagiline
- Rifampin
- Risperidone
- Ritonavir
- Rizatriptan
- Rolapitant
- Ropinirole
- Ropivacaine
- Rotigotine
- Safinamide
- Sapropterin
- Scopolamine
- Secobarbital
- Segesterone Acetate; Ethinyl Estradiol
- Selegiline
- Serotonin norepinephrine reuptake inhibitors
- Serotonin-Receptor Agonists
- Serotonin-Receptor Antagonists
- Sertraline
- Sevoflurane
- Sibutramine
- Sildenafil
- Simeprevir
- Sincalide
- Sodium Oxybate
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Solifenacin
- Sorafenib
- Spironolactone
- St. John’s Wort, Hypericum perforatum
- Sufentanil
- Sumatriptan
- Suvorexant
- Tapentadol
- Tasimelteon
- Tedizolid
- Telaprevir
- Temazepam
- Temsirolimus
- Tetrabenazine
- Tezacaftor; Ivacaftor
- Thalidomide
- Thiazide diuretics
- Thiopental
- Thioridazine
- Thiothixene
- Ticagrelor
- Tizanidine
- Tolterodine
- Torsemide
- Tramadol
- Tranylcypromine
- Trazodone
- Triamterene
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Trihexyphenidyl
- Trimethobenzamide
- Trimipramine
- Triprolidine
- Trospium
- Tucatinib
- Valerian, Valeriana officinalis
- Valproic Acid, Divalproex Sodium
- Vemurafenib
- Venlafaxine
- Vigabatrin
- Vilazodone
- Vortioxetine
- Zaleplon
- Ziconotide
- Ziprasidone
- Zolmitriptan
- Zolpidem
- Zonisamide
