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Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. |
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Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients closely for signs of respiratory depression and sedation. If concomitant use is warranted, consider prescribing naloxone for the emergency treatment of opioid overdose [ |
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Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol. |
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The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. |
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If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Discontinue Morphine Sulfate Tablets if serotonin syndrome is suspected. |
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Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that effect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine, metaxalone), monoamine oxidase (MAO) inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue). |
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MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (e.g., respiratory depression, coma) |
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Do not use Morphine Sulfate Tablets in patients taking MAOIs or within 14 days of stopping such treatment. |
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Phenelzine, tranylcypromine, linezolid. |
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May reduce the analgesic effect of Morphine Sulfate Tablets and/or precipitate withdrawal symptoms. |
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Avoid concomitant use. |
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Butorphanol, nalbuphine, pentazocine, buprenorphine. |
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Morphine may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression. |
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Monitor patients for signs of respiratory depression that may be greater than otherwise expected and decrease the dosage of Morphine Sulfate Tablets and/or the muscle relaxant as necessary. Due to the risk of respiratory depression with concomitant use of skeletal muscle relaxants and opioids, consider prescribing naloxone for the emergency treatment of opioid overdose |
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Cyclobenzaprine, metaxalone |
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The concomitant use of morphine and cimetidine has been reported to precipitate apnea, confusion, and muscle twitching in an isolated report. |
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Monitor patients for increased respiratory and CNS depression when Morphine Sulfate Tablets are used concomitantly with cimetidine. |
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Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. |
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Monitor patients for signs of diminished diuresis and/or effects on blood pressure and increase the dosage of the diuretic as needed. |
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The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. |
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Monitor patients for signs of urinary retention or reduced gastric motility when Morphine Sulfate Tablets are used concomitantly with anticholinergic drugs. |
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The concomitant use of P-gp inhibitors can increase the exposure to morphine by two- fold and can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. |
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Monitor patients for signs of respiratory depression that may be greater than otherwise expected and decrease the dosage of Morphine Sulfate Tablets and/or the P-gp inhibitor as necessary. |
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Quinidine, verapamil. |
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These are not all the possible side effects of Morphine Sulfate Tablets. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. |
Manufactured by: Alkem Laboratories 1733 Gilsinn Lane, Fenton, MO 63026 Distributed by: Ascend Laboratories, LLC Parsippany, NJ 07054 For more information, call 1-877-ASC-RX01 (877-272-7901). |
This Medication Guide has been approved by the U.S. Food and Drug Administration. |