Morphine and naltrexone (Oral)

Morphine and naltrexone treats pain that occurs long-term (typically around the clock).

Overview

Morphine and naltrexone is a prescription medication that is prescribed for severe or moderate pain for patients who need pain relief for longer durations of time (sometimes 24 hours a day). This medication should not be used as treatment for pain that takes place only every now and then, or pain that does already respond well to medication that is nonnarcotic. Nonnarcotic medication should always be the first option when possible.

Morphine is a pain medication (narcotic analgesic) that aids in the relief of pain. This medication relieves pain in the central nervous system.

Naltrexone blocks narcotic effects as it is an opioid antagonist. It mainly stops the high sensation from taking place that makes people inclined to use narcotics. Physical dependence or narcotic-like tendencies will not take place from taking this medication.

Morphine and naltrexone can only be obtained with a valid prescription from your doctor.

It is manufactured under the US brand Embeda, and is available in both capsule and extended release form.

Conditions treated

  • Moderate pain (long duration)
  • Severe pain (long duration)

Type of medicine

  • Narcotic analgesic
  • Opioid antagonist

Side Effects

In addition to the necessary benefits, medications can also cause side effects that may be undesirable at times. While not each one of these side effects will take place for every patient, they could require emergency medical care if they do take place.

Consult with your health care professional right away if you experience any of the side effects below:

More common side effects (medical care suggested):

  • Weight loss or gain (unusual)
  • Warm sensations or feelings
  • Tingling of the feet or hands
  • Swelling or bloating of the feet, lower legs, hands, arms, or face
  • Sweating suddenly
  • Sudden weight gain
  • Sleepiness
  • Shaking or trembling of the feet or hands
  • Restlessness
  • Redness of the upper chest (occasional), arms, neck, or face
  • Irritability
  • Drowsiness or tiredness
  • Depression (mental)
  • Constipation
  • Confusion
  • Chills
  • Calm and relaxed feeling

Rare side effects (medical care suggested):

  • Yellow skin or eyes
  • Warm feelings
  • Vomiting or nausea (severe)
  • Vomiting
  • Urine that is dark in color
  • Unusual weakness or tiredness
  • Unsteadiness or clumsiness
  • Tingling, prickling, numbness, itching, crawling, or burning feelings
  • Sweating
  • Reduced volume or frequency of urination
  • Redness of the upper chest, arms, neck, and face
  • Quick heartbeat
  • Pains in the abdomen, side, or stomach, potentially moving toward the back
  • Painful or difficulty when urinating
  • Nervousness
  • Nausea
  • Lower levels of responsiveness or awareness
  • Lightheadedness, faintness, or dizziness when arising quickly from a sitting or lying position
  • Labored or difficulty breathing
  • Indigestion
  • Forgetful tendencies
  • Fever
  • Feeling, hearing, or seeing things that do not actually exist
  • Dreams that are abnormal
  • Dementia
  • Delusions
  • Confusion about time, place, and identity
  • Chest tightness
  • Blurred vision
  • Appetite loss

Other kinds of side effects can also take place, but these do not usually require an appointment with your physician. This type of side effect will likely diminish throughout the course of treatment after your body has become more accustomed to the drug. In addition, your doctor can likely inform you of additional methods for reducing or preventing certain side effects. Consult with your doctor if you experience difficulty from any of the side effects below, if they become troublesome, or if you have concerns or questions regarding them.

More common side effects (medical care not required):

  • Weight loss
  • Weakness, tiredness, don't lists, drowsiness or sluggishness (unusual)
  • Unusual sleepiness or drowsiness
  • Stomach upset or discomfort
  • Sour or acid feeling in the stomach
  • Skin itchiness
  • Reduced appetite
  • Muscle stiffness for pain
  • Muscle spasm
  • Moving difficulty
  • Joint pain
  • Heartburn
  • Feeling of fullness
  • Excess gas or air in the intestines or stomach
  • Diarrhea
  • Burping
  • Anxiety

Rare side effects (medical care not required):

  • Sweating increase
  • Strength loss
  • Stomach tender feeling
  • Stomach swelling
  • Stomach pressure
  • Stomach or upper abdominal pain
  • Sleeping difficulty
  • Reduce sexual performance, drive, desire, or ability
  • Rash
  • Night sweats
  • Incapability to keep or have an erection
  • Headache
  • General sensation of illness or discomfort
  • Dry mouth
  • Dizzy feelings
  • Cold sweats

Additional side effects that are not included here can also take place for certain patients taking this medication. If other side effects are observed, consult with your doctor.

Contact your medical care professional for help and advice regarding side effects of morphine and naltrexone. Side effects can also be reported to the Food and Drug Administration by calling 1-800-FDA-1088.

Dosage

Morphine and naltrexone is intended only for patients who can tolerate opioids. If you do not know if you are tolerant of opioids or not, consult with your doctor prior to taking morphine and naltrexone.

This medication will be distributed with a medication overview summary guide. Carefully read and abide by the directions. Consult with your doctor with any questions you may have.

Never chew, crash, or break this medication. Swallow the whole capsule.

For patients who are not capable of swallowing the capsule, they may puncture and empty the medication into a little portion of applesauce. Mix well and swallow, do not chew. After you believe you have swallowed the medication, drink one glass full of water to ensure the medication has been completely swallowed.

Different patients will be given different doses of this medication. Always follow the instructions given by your doctor or the medication label instructions. The information included here will summarize only typical doses of morphine and naltrexone. If you were prescribed a dose that is different from this information, do not adjust it unless instructed otherwise by your physician.

The quantity of medication you take will depend on how strong the drug is. Also, the prescribed quantity of doses taken per day in the allotted time between each dose as well as the total duration for which the medication taken depends on the medical issue for which morphine and naltrexone is prescribed.

Oral form (capsule) dosage information for pain:

  • Patients using Embeda┬« for the initial pain medication

O Adults: Initially, take one capsule every day. Your physician may change your dose as required.

O Children: Pediatrician must calculate dose.

  • Patients changing from a different oral morphine to Embeda┬«

O Adults: The total amount that should be taken per day equals half the morphine dose that you were prescribed before. The total dose may be taken separately once every 12 hours, or it may be taken once daily.

O Children: Pediatrician must determine child's dose.

Patients who miss a prescribed dose of morphine and naltrexone should take it right when they recognize that the dose had been missed. The patients may then resume their original dosing schedule. Never take a double dose of morphine and naltrexone.

Interactions

While some prescription drugs should not ever be combined, in certain circumstances two medications can be used despite the possibility that an interaction could take place. Under the circumstances, your physician will likely want to alter your dose, or they may decide to pursue other precautions for your safety. While taking morphine and naltrexone, it is essential that your doctor is aware of any other medications (especially the following) that you are taking. The interactions on the list below have been chosen due to their possible significance. The list is not entirely all-inclusive.

Taking this medication with any of the drugs on the list below is not typically suggested. Your physician will likely choose not to prescribe morphine and naltrexone, or they may alter other prescriptions that you may be on.

  • Tramadol
  • Tilidine
  • Tapentadol
  • Sufentanil
  • Remifentanil
  • Propoxyphene
  • Piritramide
  • Paregoric
  • Papaveretum
  • Oxymorphone
  • Oxycodone
  • Opium Alkaloids
  • Opium
  • Nicomorphine
  • Naltrexone
  • Nalbuphine
  • Morphine Sulfate Liposome
  • Morphine
  • Methadone
  • Meperidine
  • Levorphanol
  • Ketobemidone
  • Hydromorphone
  • Hydrocodone
  • Fentanyl
  • Ethylmorphine
  • Diphenoxylate
  • Dihydrocodeine
  • Difenoxin
  • Diacetylmorphine
  • Codeine
  • Butorphanol
  • Buprenorphine
  • Anileridine
  • Alphaprodine
  • Alfentanil

It is not typically suggested to take morphine and naltrexone with any of the prescription drugs on the list below. However, certain unique circumstances may require the combination. When both medications are prescribed at the same time, your physician will likely adjust your frequency or amount of dose for either one or both medications.

  • Zopiclone
  • Zolpidem
  • Ziprasidone
  • Zaleplon
  • Verapamil
  • Trimeprazine
  • Triflupromazine
  • Trifluperidol
  • Trifluoperazine
  • Triazolam
  • Tranylcypromine
  • Tramadol
  • Topiramate
  • Toloxatone
  • Tolonium Chloride
  • Tocophersolan
  • Tizanidine
  • Tilidine
  • Ticagrelor
  • Thiothixene
  • Thioridazine
  • Thiopropazate
  • Thiethylperazine
  • Temazepam
  • Telaprevir
  • Tapentadol
  • Suvorexant
  • Sunitinib
  • Sulpiride
  • Sufentanil
  • Sodium Oxybate
  • Simeprevir
  • Sertindole
  • Selegiline
  • Secobarbital
  • Samidorphan
  • Safinamide
  • Ritonavir
  • Risperidone
  • Remoxipride
  • Remifentanil
  • Rasagiline
  • Ranolazine
  • Ramelteon
  • Quinidine
  • Quetiapine
  • Quercetin
  • Quazepam
  • Propoxyphene
  • Propofol
  • Promethazine
  • Promazine
  • Prochlorperazine
  • Procarbazine
  • Primidone
  • Prazepam
  • Piritramide
  • Pipotiazine
  • Piperacetazine
  • Pimozide
  • Pimavanserin
  • Phenobarbital
  • Phenelzine
  • Perphenazine
  • Periciazine
  • Perazine
  • Pentobarbital
  • Pentazocine
  • Pargyline
  • Paregoric
  • Papaveretum
  • Paliperidone
  • Oxymorphone
  • Oxycodone
  • Oxazepam
  • Orphenadrine
  • Opium Alkaloids
  • Opium
  • Olanzapine
  • Nitrous Oxide
  • Nitrazepam
  • Nilotinib
  • Nicomorphine
  • Nialamide
  • Naloxone
  • Naloxegol
  • Nalorphine
  • Nalmefene
  • Nalbuphine
  • Morphine Sulfate Liposome
  • Morphine
  • Moricizine
  • Molindone
  • Moclobemide
  • Midazolam
  • Methylnaltrexone
  • Methylene Blue
  • Methotrimeprazine
  • Methohexital
  • Methocarbamol
  • Methdilazine
  • Methadone
  • Metaxalone
  • Mesoridazine
  • Meptazinol
  • Mephobarbital
  • Meperidine
  • Melperone
  • Medazepam
  • Meclizine
  • Lurasidone
  • Loxapine
  • Lormetazepam
  • Lorazepam
  • Lopinavir
  • Linezolid
  • Levorphanol
  • Lazabemide
  • Ketoconazole
  • Ketobemidone
  • Ketazolam
  • Ketamine
  • Ivacaftor
  • Itraconazole
  • Isoflurane
  • Isocarboxazid
  • Iproniazid
  • Iloperidone
  • Hydroxyzine
  • Hydromorphone
  • Hydrocodone
  • Hexobarbital
  • Halothane
  • Haloperidol
  • Halazepam
  • Furazolidone
  • Fospropofol
  • Fluspirilene
  • Flurazepam
  • Fluphenazine
  • Flunitrazepam
  • Flibanserin
  • Fentanyl
  • Felodipine
  • Ethylmorphine
  • Ethopropazine
  • Ethchlorvynol
  • Eszopiclone
  • Estazolam
  • Erythromycin
  • Enflurane
  • Droperidol
  • Dronedarone
  • Doxylamine
  • Doxorubicin Hydrochloride Liposome
  • Doxorubicin
  • Donepezil
  • Diphenoxylate
  • Diphenhydramine
  • Diltiazem
  • Dihydrocodeine
  • Difenoxin
  • Dichloralphenazone
  • Diazepam
  • Diacetylmorphine
  • Dezocine
  • Dexmedetomidine
  • Dantrolene
  • Cyclosporine
  • Cyclobenzaprine
  • Conivaptan
  • Codeine
  • Cobicistat
  • Clozapine
  • Clorgyline
  • Clorazepate
  • Clonazepam
  • Clobazam
  • Clarithromycin
  • Cimetidine
  • Chlorzoxazone
  • Chlorpromazine
  • Chlordiazepoxide
  • Chloral Hydrate
  • Carvedilol
  • Carphenazine
  • Carisoprodol
  • Cariprazine
  • Carbinoxamine
  • Captopril
  • Butorphanol
  • Butalbital
  • Butabarbital
  • Buspirone
  • Buprenorphine
  • Bromopride
  • Bromazepam
  • Brofaromine
  • Benperidol
  • Baclofen
  • Azithromycin
  • Asenapine
  • Aripiprazole
  • Anileridine
  • Amobarbital
  • Amisulpride
  • Amiodarone
  • Alvimopan
  • Alprazolam
  • Alfentanil
  • Acepromazine
  • Abiraterone

Taking morphine and naltrexone with the medications below may trigger a higher chance of some side effects taking place, but the combination of medications could prove to be the most optimal form of treatment for your unique condition. If your doctor chooses to prescribe both medications, they may adjust the frequency or dose for either or both medications.

  • Esmolol
  • Gabapentin
  • Gabapentin Enacarbil
  • Rifampin
  • Somatostatin
  • Yohimbine

Other types of interactions may take place when taking this medication. Ask your doctor if morphine and naltrexone can be taken around mealtime or when eating some kinds of food due to the likelihood of interaction taking place. The use of tobacco or alcohol with some medications can also trigger significant interactions to take place. The interaction listed below was chosen due to the potentially significant interaction factor with morphine and naltrexone. This list is not all-inclusive.

The use of the following medication is not typically suggested in addition to morphine and naltrexone, however, certain circumstances may require the combination. If prescribed at the same time, your physician may decide to adjust your dose or the frequency of the medication. They also can offer you the instructions regarding how tobacco, alcohol, or food impact the use of this medication.

  • Ethanol

Patients who have other kinds of medical issues could experience impacts in the effectiveness of morphine and naltrexone. Be sure that your physician is aware of other medical issues you may have, specifically:

  • Alcohol abuse (including history of)
  • Brain tumor (history of)
  • Lung or breathing issues (such as sleep apnea or low levels of oxygen)
  • Central nervous system depression (history of)
  • Chronic obstructive pulmonary disease
  • Heart conditions that are severe (Cor pulmonale)
  • Mental illness (including history of)
  • Head injury (including history of)
  • Kidney disease
  • Gallbladder disease
  • Low blood pressure (hypotension)
  • Seizures (including history of) take caution, conditions can be made worse
  • Issues urinating
  • Enlarged prostate (prostatic hypertrophy)
  • Thyroid issues
  • Weakened condition'take caution, morphine and naltrexone could raise the likelihood of more severe side effects taking place
  • Swelling or inflammation of the pancreas (pancreatitis)
  • Liver disease' take caution, side effects would have a higher likelihood of taking place due to slower extraction of the medication out of the body

Warnings

Your doctor must monitor your progress closely during the time that you are on morphine and naltrexone. Regular appointments will give your physician a chance to see whether or not the medication is working correctly, and it will allow them to see if continuing treatment with the medication would be beneficial for you.

It is highly dangerous and illegal for another person to take your medication. Always keep your medication in a place that is secure and safe. This medication could be highly desirable for people who could be addicted.

This medication can potentially contribute to the effects of CNS depressants and alcohol. CNS depressants include any medication that makes you drowsy, such as dental anesthetics, muscle relaxants, barbiturates or seizure medication, other kinds of prescription medication for pain or narcotics, sleeping medication, tranquilizers, sedatives, or cold and allergy medication. Consult with your physician prior to taking any medications listed above while on morphine and naltrexone.

Be aware that this medication could potentially be habit forming. If you are getting the impression that the medication is not working the way that it should, do not take a dose that is more than what was prescribed for you. Contact your physician for further directions.

Fainting, lightheadedness, or dizziness could take place when getting up quickly from a sitting or lying position. Slowly getting up could be helpful to reduce this issue. In addition, spending time lying down could be helpful for relief of lightheadedness or dizziness.

Severe constipation can take place for patients who have taken narcotics for a very long time. Your physician may try to prevent this from happening by instructing you to drink excessive fluids, take laxatives, or to raise the total quantity of fiber you are getting in your diet. Follow the instructions closely, because more severe issues can take place due to continuing constipation.

Do not take an amount of this medication that is greater than prescribed, and do not take it more frequently than instructed by your doctor. It could be life-threatening to do so. Signs of overdose are extreme weakness and tiredness; clammy, cold skin; seizures; slow heartbeat; breath shortness; or dizziness. Contact your physician immediately if you observe any of these symptoms.

Prior to having dental surgery or surgery of another kind, inform the healthcare professional that you are taking morphine and naltrexone. Severe side effects could occur if other medications are taken in addition to morphine and naltrexone.

Patients may feel lightheaded, drowsy, or dizzy when taking this medication. Be sure to be aware of your own personal reaction to morphine and naltrexone prior to operating machinery, driving, or performing other activities that could be potentially dangerous if you do not know how you may react.

Anaphylaxis is an allergic reaction that is severe and may take place after taking morphine and naltrexone. This condition could be deadly and emergency medical care is required if it occurs. Contact your physician immediately if you experience swelling of the mouth, face, or hands; difficulty swallowing; difficulty breathing; hoarseness, itching, or rash while taking morphine and naltrexone.

If you are a patient who has been taking this medication regularly for a period of at least two weeks, be sure not to discontinue use suddenly or quit without consulting with your physician first. You could be advised to lower the dose of medication you are taking gradually prior to completely ending treatment. Your physician may also recommend that you take a different narcotic for a short time period to reduce the likelihood that side effects will take place.

Be sure to inform your physician if you are currently pregnant or have future plans to attempt to be pregnant while on morphine and naltrexone. This medication can make neonatal withdrawal syndrome occur for your baby, which is a deadly condition. Inform your physician immediately if your child experiences the following signs: inability to gain weight, vomiting, weight loss, tremor or shakiness, irritability, cries that are high-pitched, diarrhea, or sleep patterns that may be abnormal.

Other medications should not be taken unless approved previously by your physician. This refers to all prescription medications, but also products that are nonprescription, such as herbal supplements or vitamins.

When contemplating whether or not a medication is right for you, consider the potential dangers of taking the medication but also examine the benefits it could provide. You should make this decision carefully with your physician. Consider the following aspects regarding this medication:

Individuals with allergies who have previously had allergic or unusual reactions to any medications including this one should inform their physician of the details of the allergic reaction. Patients should also let their doctors know if they have allergies of other kinds, including to animals, preservatives, dyes, or foods. For products that are not prescription, be sure to read the medication summary ingredients list carefully.

Children should not take morphine and naltrexone as appropriate research has not yet been conducted as to whether or not age has an impact on how morphine and naltrexone behaves, especially for children. It has not yet been determined whether or not this medication is both effective and safe for children.

Elderly patients who are taking morphine and naltrexone will not likely encounter issues that could inhibit the effectiveness of this medication. Current research has not identified any potential issues for this medication and geriatric patients. However, patients who are older have a higher likelihood of already having age-related lung, liver, kidney, or heart issues, which could require additional caution and a reduced dose for geriatric patients.

Patients who are pregnant should take this medication only when required. Current research has not yet been conducted for humans, however animal studies have demonstrated a negative effect to the fetus.

Women who breastfeed should weigh the potential benefits against the possible risks prior to taking morphine and naltrexone while breastfeeding.

Storage

Store this medication in a container that is sealed, and keep it at room temperature. Ensure the container is far from freezing or hot temperatures, and is away from direct light and moisture. Always keep out of children's reach.

Medication that is expired or no longer required should be disposed of.

Summary

Morphine and naltrexone is a prescription drug that is prescribed for severe or even moderate pain for patients who need pain relief for longer durations of time (sometimes even 24 hours a day). This medication should not be used as treatment for pain that only takes place every now and then, or pain that does already respond well to medication that is nonnarcotic. Nonnarcotic medication should always be the first option when possible.