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Drug Interactions between Choletec and OMS

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

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Interactions between your drugs

Moderate

morphine mebrofenin

Applies to: OMS (morphine) and Choletec (mebrofenin)

MONITOR: Prior administration of opioids may delay transit of Technetium Tc 99m mebrofenin due to opioid-induced contraction of the distal common bile duct, which may result in nonvisualization. In one study, a group of investigators reviewed the records of 198 emergency department patients who underwent nuclear hepatobiliary imaging, after excluding those with evidence for pathologic common bile duct (CBD) obstruction. Delayed CBD visualization occurred in 28.6% of subjects who had received opioids (n=56) and 12.0% of subjects who had not received opioids, while delayed imaging was performed in 77.8% and 53.5%, respectively. The relative risk of delayed CBD visualization was 1.46 for meperidine, 4.18 for morphine, and 2.38 for any opioid. Nonetheless, low-dose intravenous morphine has been used during cholescintigraphy to increase biliary pressure, thereby allowing for visualization of gallbladder when there is failure to visualize 60 minutes or more after Technetium Tc 99m mebrofenin injection. Compared to standard cholescintigraphy, morphine-augmented cholescintigraphy has been shown to reduce imaging time and the number of false-positive results.

MANAGEMENT: Nonvisualization may occur in patients who have been receiving opioids prior to cholescintigraphy.

References

  1. "Product Information. Choletec (mebrofenin)." Bracco Diagnostics Inc (2012):
  2. Kim EE, Pjura G, Lowry P, Nguyen M, Pollack M "Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis." AJR Am J Roentgenol 147 (1986): 1177-9
  3. Fink-Bennett D, Balon H, Robbins T, Tsai D "Morphine-augmented cholescintigraphy: its efficacy in detecting acute cholecystitis." J Nucl Med 32 (1991): 1231-3
  4. Flancbaum L, Choban PS, Sinha R, Jonasson O "Morphine cholescintigraphy in the evaluation of hospitalized patients with suspected acute cholecystitis." Ann Surg 220 (1994): 25-31
  5. Chen CC, Holder LE, Maunoury C, Drachenberg CI "Morphine augmentation increases galllbladder visualization in patients pretreated with cholecystokinin." J Nucl Med 38 (1997): 644-7
  6. Oates E, Selland DL, Chin CT, Achong DM "Gallbladder nonvisualization with pericholecystic rim sign: morphine-augmentation optimizes diagnosis of acute cholecystitis." J Nucl Med 37 (1996): 267-9
View all 6 references

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Drug and food interactions

Major

morphine food

Applies to: OMS (morphine)

GENERALLY AVOID: Alcohol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics including morphine and diamorphine. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

GENERALLY AVOID: Consumption of alcohol while taking some sustained-release formulations of morphine may cause rapid release of the drug, resulting in high systemic levels of morphine that may be potentially lethal. Alcohol apparently can disrupt the release mechanism of some sustained-release formulations. The interaction was observed in in vitro studies using a 24-hour morphine formulation (Avinza 30 mg capsule, available in the U.S. from Ligand Pharmaceuticals). When the capsule was mixed with 900 mL of buffer solutions containing ethanol 20% and 40%, the dose of morphine that was released was alcohol concentration-dependent, leading to a more rapid release of morphine. Although the clinical relevance of this finding is unknown, 'dose-dumping' into the bloodstream is conceivable.

MANAGEMENT: Until more information is available, patients taking sustained-release formulations of morphine should not consume alcohol or use medications that contain alcohol. In general, potent narcotics such as morphine or diamorphine should not be combined with alcohol.

References

  1. "Product Information. Avinza (morphine)." Ligand Pharmaceuticals (2005):
  2. Ghalie R "Dear Health Care Professional. http://www.fda.gov/medwatch/safety/2005/AVINZA_DHCP_Letter_Oct2005.pdf" (2005):
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  4. Cerner Multum, Inc. "Canadian Product Information." O 0 (2015):
View all 4 references

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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

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