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Drug Interactions between MS Contin and tofacitinib

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

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Interactions between your drugs

Moderate

morphine tofacitinib

Applies to: MS Contin (morphine) and tofacitinib

MONITOR: Coadministration of Janus kinase (JAK) inhibitors with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or opioids may increase the risk of gastrointestinal (GI) perforation. Patients with a prior history of peptic ulceration or diverticular disease may also have an increased risk. Adverse events of diverticulitis and GI perforation have been infrequently reported in clinical studies and postmarketing use of JAK inhibitors such as baricitinib, ruxolitinib, tofacitinib, and upadacitinib. However, the role of JAK inhibition in these events has not been determined. In studies with rheumatoid arthritis and ulcerative colitis patients, many were receiving background therapy with NSAIDs or corticosteroids.

MANAGEMENT: Caution is recommended when using JAK inhibitors in patients with a history of peptic ulceration or diverticular disease and in patients receiving concomitant treatment with drugs associated with an increased risk of GI perforation such as corticosteroids, NSAIDs, and opioids. Patients should be advised to contact their healthcare provider if they experience signs and symptoms of GI perforation such as severe abdominal pain, fever, chills, nausea, or vomiting.

References (15)
  1. Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT (2011) "Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding." Gastroenterology, 140, p. 1427-33
  2. Medicines and Healthcare products Regulatory Agency (2020) Baricitinib (Olumiant¥): increased risk of diverticulitis, particularly in patients with risk factors. https://www.gov.uk/drug-safety-update/baricitinib-olumiant-increased-risk-of-diverticulitis-particularly-in-patients-with-risk-factors
  3. (2021) "Product Information. Olumiant (bARICITinib)." Eli Lilly Australia Pty Ltd, vA7_April2021
  4. (2023) "Product Information. Olumiant (baricitinib)." Eli Lilly and Company Ltd
  5. Hoisnard L, Lebrun-Vignes B, Maury S, et al. (2022) "Adverse events associated with JAK inhibitors in 126,815 reports from the WHO pharmacovigilance database." Sci Rep, 12, p. 7140
  6. (2023) "Product Information. Olumiant (baricitinib)." Lilly, Eli and Company, DailyMed
  7. (2023) "Product Information. Xeljanz (tofacitinib)." Pfizer U.S. Pharmaceuticals Group
  8. (2023) "Product Information. Xeljanz (tofacitinib)." Pfizer Ltd
  9. (2023) "Product Information. Xeljanz (tOFACitinib)." Pfizer Australia Pty Ltd, pfpxelja10423
  10. (2023) "Product Information. Rinvoq (upadacitinib)." AbbVie US LLC
  11. (2023) "Product Information. Rinvoq (upadacitinib)." AbbVie Ltd
  12. (2023) "Product Information. Rinvoq (upadacitinib)." AbbVie Pty Ltd, 8
  13. (2022) "Product Information. Olumiant (baricitinib)." Eli Lilly Canada Inc, 260967
  14. (2022) "Product Information. Xeljanz (tofacitinib)." Pfizer Canada ULC, 258173
  15. (2022) "Product Information. Rinvoq (upadacitinib)." AbbVie Corporation, 262176

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."
Moderate

tofacitinib food

Applies to: tofacitinib

MONITOR: Grapefruit juice may increase the plasma concentrations of tofacitinib. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The extent and clinical significance are unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.

MANAGEMENT: Until more information is available, some authorities recommend avoiding consumption of grapefruit juice during tofacitinib therapy (Canada). Patients receiving tofacitinib therapy who ingest grapefruits or grapefruit juice should be monitored for adverse effects and undue fluctuations in plasma drug levels.

References (1)
  1. (2024) "Product Information. Xeljanz (tofacitinib)." Pfizer Canada ULC

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

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