morphine and naltrexonePronunciation
Generic Name: morphine and naltrexone (MOR feen and nal TREX one)
Brand Name: Embeda
What is morphine and naltrexone?
Morphine is an opioid pain medication. An opioid is sometimes called a narcotic. Naltrexone blocks certain effects of opioid medication, including feelings of well-being that can lead to opioid abuse.
Morphine and naltrexone is a combination medicine used to treat moderate to severe pain when around-the-clock pain relief is needed for a long time period. Naltrexone is included in this medication to prevent the misuse of the narcotic ingredient.
Morphine and naltrexone is an extended-release opioid pain medicine that is not for use on an as-needed basis for pain.
Morphine and naltrexone may also be used for purposes not listed in this medication guide.
What is the most important information I should know about morphine and naltrexone?
You should not use morphine and naltrexone if you have severe asthma or breathing problems, or a bowel obstruction called paralytic ileus.
Do not use this medicine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
Morphine can slow or stop your breathing. Never use this medicine in larger amounts, or for longer than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose. Morphine may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.
MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.
Tell your doctor if you are pregnant. Morphine and naltrexone may cause life-threatening withdrawal symptoms in a newborn.
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with morphine and naltrexone.
What should I discuss with my healthcare provider before taking morphine and naltrexone?
Do not use morphine and naltrexone if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
You should not use morphine and naltrexone if you have ever had an allergic reaction to a narcotic medicine, or if you have:
severe asthma or breathing problems; or
a bowel obstruction called paralytic ileus.
You should not use morphine and naltrexone unless you are already using a similar opioid medicine and are tolerant to it. Opioid medicines include codeine, fentanyl, hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone, oxycodone (OxyContin, Percocet), and many others. Ask your doctor if you are not sure you are opioid-tolerant.
Some medicines can interact with morphine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.
To make sure morphine and naltrexone is safe for you, tell your doctor if you have:
any type of breathing problem or lung disease;
a history of head injury, brain tumor, or seizures;
a history of drug abuse, alcohol addiction, or mental illness;
enlarged prostate, urination problems;
liver or kidney disease;
abnormal curvature of the spine that affects your breathing;
Addison's disease (an adrenal gland disorder);
problems with your gallbladder, pancreas, or thyroid.
Tell your doctor if you are pregnant or plan to become pregnant. If you use morphine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks.
Morphine and naltrexone can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using morphine and naltrexone.
How should I use morphine and naltrexone?
Follow all directions on your prescription label. Morphine can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.
Morphine may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away morphine and naltrexone is against the law.
Stop taking all other around-the-clock narcotic pain medications when you start taking morphine and naltrexone.
You may take morphine and naltrexone with or without food. Morphine and naltrexone is usually taken 1 or 2 times each day. Each dose should be spaced at least 12 hours apart. Follow your doctor's instructions.
Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose.
To make swallowing easier, you may open the extended-release capsule and sprinkle the medicine into a spoonful of applesauce. Mix only one dose and swallow this mixture right away without chewing. Drink a glass of water to make sure all the medicine has been swallowed. Flush the empty capsule down a toilet.
Do not stop using morphine and naltrexone suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using morphine and naltrexone.
Never crush or break a morphine and naltrexone pill to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death with the misuse of morphine and naltrexone and similar prescription drugs.
Store at room temperature away from moisture, heat, and light. Keep track of the amount of medicine used from each new bottle. Morphine and naltrexone is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
Do not keep leftover morphine and naltrexone pills. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, flush any unused pills down the toilet.
What happens if I miss a dose?
Since morphine and naltrexone is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
Morphine and naltrexone is not for use on an as-needed basis for pain.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A morphine and naltrexone overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.
What should I avoid while using morphine and naltrexone?
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with morphine and naltrexone. Check your food and medicine labels to be sure these products do not contain alcohol.
This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how morphine and naltrexone will affect you. Dizziness or severe drowsiness can cause falls or other accidents.
Morphine and naltrexone side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; chest pain, anxiety, pounding heartbeats, fainting; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
weak or shallow breathing;
a light-headed feeling, like you might pass out;
infertility, missed menstrual periods;
impotence, sexual problems, loss of interest in sex; or
low cortisol levels-- nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Morphine and naltrexone is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.
Common side effects may include:
constipation, nausea, vomiting, stomach pain;
drowsiness, dizziness; or
headache, tired feeling.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
Morphine and naltrexone dosing information
Usual Adult Dose for Chronic Pain:
The following dosing recommendations can be considered approaches to what is actually a series of clinical decisions over time in the management of the pain of an individual patient.
All doses expressed as MORPHINE/NALTREXONE
Use as the FIRST OPIOID ANALGESIC or those who are not opioid tolerant:
Initial dose: 20 mg/0.8 mg orally every 24 hours
CONVERSION FROM OTHER OPIOIDS:
-Discontinue all other around-the-clock opioids
-Initiate at 30 mg/1.2 mg orally every 24 hours
CONVERSION FROM OTHER ORAL MORPHINE FORMULATIONS:
-Give one-half of the patient's total daily morphine dose orally every 12 hours OR give the total daily morphine dose orally once daily
CONVERSION FROM PARENTERAL MORPHINE OR OTHER OPIOIDS:
-When converting from parenteral morphine: 1 mg of parenteral morphine is equivalent to approximately 2 to 6 mg of oral morphine; typically the dose of oral morphine is 3 times the daily parenteral morphine dose.
-When converting from other opioids (parenteral or oral): The initial morphine-naltrexone dose should be one-half of the estimated daily morphine requirement; manage inadequate analgesia by supplementing with immediate-release morphine.
CONVERSION FROM METHADONE:
-Methadone has a long half-life and can accumulate in the plasma; the ratio of other opioid agonists to methadone may vary widely. Close monitoring will be of particular importance.
MAINTENANCE DOSE: Individually titrate to a dose that provides adequate analgesia and minimizes adverse reactions; dose adjustments may be made every 1 to 2 days.
BREAKTHROUGH PAIN: If the level of pain increases after dose stabilization, attempt to identify the source before increasing dose
-Rescue medication with an appropriate immediate-release analgesia may be helpful
-For patients experiencing inadequate analgesia with once-daily dosing, a twice daily regimen may be considered.
-An opioid tolerant patient is one who has been receiving for 1-week or longer at least: oral morphine 60 mg/day, transdermal fentanyl patch 25 mcg per hour, oral oxycodone 30 mg/day, oral hydromorphone 8 mg/day, oral oxymorphone 25 mg/day, or an equianalgesic dose of another opioid.
-The 100 mg/4 mg capsules are reserved for use in opioid-tolerant patients only.
-Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy.
-The first dose of this drug may be taken with the last dose of any immediate-release opioid due to its extended-release characteristics.
Use: For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
What other drugs will affect morphine and naltrexone?
Some medicines can cause unwanted or dangerous effects when used with morphine and naltrexone. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.
Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking morphine and naltrexone with a sleeping pill, other narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Other drugs may interact with morphine and naltrexone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
More about morphine/naltrexone
- Other brands: Embeda
Related treatment guides
Where can I get more information?
- Your pharmacist can provide more information about morphine and naltrexone.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
- Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2012 Cerner Multum, Inc. Version: 5.06.
Last reviewed: July 29, 2016
Date modified: October 14, 2016