Morphine Naltrexone

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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

  1. abdominal pain
  2. adrenocortical insufficiency
  3. amenorrhea
  4. anaphylactoid reactions
  5. anorexia
  6. anxiety
  7. arthralgia
  8. asthenia
  9. blurred vision
  10. bradycardia
  11. cardiac arrest
  12. chills
  13. cholecystitis
  14. confusion
  15. constipation
  16. depression
  17. diarrhea
  18. dizziness
  19. drowsiness
  20. dyspepsia
  21. dyspnea
  22. dysuria
  23. elevated hepatic enzymes
  24. euphoria
  25. fatigue
  26. flatulence
  27. flushing
  28. GI obstruction
  29. gonadal suppression
  30. hallucinations
  31. headache
  32. hyperamylasemia
  33. hyperhidrosis
  34. hypertension
  35. hyponatremia
  36. hypotension
  37. ileus
  38. impotence (erectile dysfunction)
  39. infertility
  40. irritability
  41. lethargy
  42. libido decrease
  43. malaise
  44. memory impairment
  45. miosis
  46. myalgia
  47. nausea
  48. neonatal opioid withdrawal syndrome
  49. orthostatic hypotension
  50. palpitations
  51. pancreatitis
  52. paresthesias
  53. peripheral edema
  54. physiological dependence
  55. pruritus
  56. psychological dependence
  57. rash
  58. respiratory depression
  59. restlessness
  60. rhinorrhea
  61. serotonin syndrome
  62. SIADH
  63. sinus tachycardia
  64. syncope
  65. tolerance
  66. tremor
  67. urinary retention
  68. vomiting
  69. weakness
  70. withdrawal
  71. 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

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