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Drug Interactions between Equaline Heartburn Relief and Morphine Sulfate SR

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

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Interactions between your drugs

Moderate

raNITIdine morphine

Applies to: Equaline Heartburn Relief (ranitidine) and Morphine Sulfate SR (morphine)

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

  1. Cerner Multum, Inc. "Canadian Product Information." O 0 (2015):
  2. Aasmundstad T A, Størset P "Influence of ranitidine on the morphine-3-glucuronide to morphine-6-glucuronide ratio after oral administration of morphine in humans" Hum Exp Toxicol 6 (1998): 347-52

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Drug and food interactions

Major

morphine food

Applies to: Morphine Sulfate SR (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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Minor

raNITIdine food

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

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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.

See also

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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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