avinza and Sodium biphosphate Interactions

Interactions between avinza(morphine) and Sodium biphosphate (sodium biphosphate)

morphine and sodium biphosphate (Major Drug-Drug)

MONITOR CLOSELY: The risk of seizures induced by the use of oral sodium phosphate products for bowel cleansing may be increased in patients on concomitant medications that can lower the seizure threshold such as selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. Rare cases of generalized tonic-clonic seizures and/or loss of consciousness in association with low serum osmolality and electrolyte abnormalities (e.g., hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia) have been reported with the use of sodium phosphate products in patients with no prior history of seizures. The condition resolved with correction of fluid and electrolyte abnormalities.

MANAGEMENT: Caution is advised if oral sodium phosphates are prescribed for bowel cleansing in patients treated with agents that can lower the seizure threshold. Oral sodium phosphate preparations should not be used if these patients have impaired renal function or perfusion, dehydration, or uncorrected electrolyte abnormalities. Baseline and post-procedure labs including serum electrolytes, calcium, phosphate, BUN, and creatinine should be considered in patients at increased risk for seizures. Patients should be advised not to exceed the recommended dosage of their oral sodium phosphate preparation and to drink sufficient quantities of clear fluids during bowel cleansing. Limited data suggest that administration of an electrolyte rehydration solution may attenuate the electrolyte abnormalities and hypovolemia.