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Drug Interactions between Berkley and Jensen Acid Reducer Maximum Strength and morphine liposomal

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

raNITIdine morphine liposomal

Applies to: Berkley and Jensen Acid Reducer Maximum Strength (ranitidine) and morphine liposomal

MONITOR: Ranitidine may increase the active metabolites and effects of morphine. Diamorphine is a prodrug of morphine and, according to its manufacturer, the mechanism of this interaction may involve inhibition of morphine glucuronidation by ranitidine. Morphine is metabolized to morphine-3-glucuronide (M3G) which has no opioid activity, and morphine-6-glucuronide (M6G), which is a potent opioid receptor agonist. In a double-blind cross-over study on 8 volunteers, oral morphine was administered with ranitidine or placebo. Compared to placebo, ranitidine significantly reduced the individual serum M3G/M6G ratio and tended to increase the systemic exposure (AUC) of morphine. In contrast, ranitidine had no significant effect on the urinary M3G/M6G ratio.

MANAGEMENT: Caution is advised when diamorphine or morphine are used with ranitidine. Patients should be monitored for increased opioid effects. A dose reduction of the opioid may be considered if an interaction is suspected.

References (2)
  1. Cerner Multum, Inc. (2015) "Canadian Product Information."
  2. Aasmundstad T A, Størset P (1998) "Influence of ranitidine on the morphine-3-glucuronide to morphine-6-glucuronide ratio after oral administration of morphine in humans" Hum Exp Toxicol, 6, p. 347-52

Drug and food interactions

Minor

raNITIdine food

Applies to: Berkley and Jensen Acid Reducer Maximum Strength (ranitidine)

H2 antagonists may reduce the clearance of nicotine. Cimetidine, 600 mg given twice a day for two days, reduced clearance of an intravenous nicotine dose by 30%. Ranitidine, 300 mg given twice a day for two days, reduced clearance by 10%. The clinical significance of this interaction is not known. Patients should be monitored for increased nicotine effects when using the patches or gum for smoking cessation and dosage adjustments should be made as appropriate.

References (1)
  1. Bendayan R, Sullivan JT, Shaw C, Frecker RC, Sellers EM (1990) "Effect of cimetidine and ranitidine on the hepatic and renal elimination of nicotine in humans." Eur J Clin Pharmacol, 38, p. 165-9

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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