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Drug Interactions between mexiletine and MS Contin

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

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Interactions between your drugs

Moderate

mexiletine morphine

Applies to: mexiletine and MS Contin (morphine)

MONITOR: Opioids may reduce the rate of absorption and onset of action of oral mexiletine. The mechanism is delayed gastric emptying by the opioid. Clinical data are limited. Plasma levels of mexiletine were decreased by 31% to 50% after 3 hours in patients who had also received diamorphine or morphine, compared to patients who did not receive opioids. Subtherapeutic mexiletine levels occurred in 47% of patients who received diamorphine and in 25% of patients who received morphine.

MANAGEMENT: Monitoring for altered efficacy is advisable.

References (4)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  3. Pottage A, Campbell RW, Achuff SC, Murray A, Julian DG, Prescott LF (1978) "The absorption of oral mexiletine in coronary care patients." Eur J Clin Pharmacol, 13, p. 393-9
  4. Smyllie HC, Doar JW, Head CD, Leggett RJ (1984) "A trial of intravenous and oral mexiletine in acute myocardial infarction." Eur J Clin Pharmacol, 26, p. 537-42

Drug and food interactions

Major

morphine food

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

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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