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Drug Interactions DRUG INTERACTIONS Table 1 includes clinically significant drug interactions with MS CONTIN. Table 1: Clinically Significant Drug Interactions with MS CONTIN Benzodiazepines and Other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the Bicalutamide (Casodex)- FDA of hypotension, respiratory depression, profound sedation, coma, and Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum. Intervention: Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.

Follow patients closely for signs of respiratory depression and sedation. Examples: Benzodiazepines and other sedative hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol. Serotonergic Drugs Clinical Impact: The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome.

Intervention: If concomitant use is warranted, Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum observe the patient, particularly during treatment initiation and dose adjustment. Discontinue MS CONTIN if serotonin syndrome is suspected. Examples: Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that effect the serotonin neurotransmitter system (e.

Monoamine Oxidase Inhibitors (MAOIs) Clinical Impact: MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (e. Intervention: Do not use MS CONTIN in patients taking MAOIs or within 14 days of stopping such treatment. Intervention: Avoid concomitant use. Examples: butorphanol, nalbuphine, pentazocine, buprenorphine Muscle Relaxants Clinical Impact: Morphine may enhance the neuromuscular blocking deal with challenges of skeletal muscle relaxants and produce an increased degree of respiratory depression.

Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. Intervention: Monitor patients for signs of urinary retention or reduced gastric motility when MS CONTIN is used concomitantly with anticholinergic drugs.

P-Glycoprotein (P-gp) Inhibitors Clinical Impact: The concomitant use of PGP-inhibitors can increase the exposure to morphine by about two-fold and can increase risk of hypotension, respiratory depression, profound sedation, coma, and death.

Examples: Quinidine Drug Abuse And Dependence Controlled Substance MS CONTIN contains morphine, a Schedule II controlled substance. Abuse MS CONTIN contains morphine, a substance with Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum high potential for abuse similar to other opioids including fentanyl, hydrocodone, hydromorphone, methadone, oxycodone, oxymorphone, and tapentadol.

Efridol Specific to Abuse of MS CONTIN MS CONTIN is for oral use only. Dependence Both tolerance and physical dependence can develop during chronic opioid therapy. Opioid Analgesic Risk Evaluation And Mitigation Strategy (REMS) To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a Risk Evaluation and Mitigation Strategy (REMS) for these products.

Healthcare providers are strongly encouraged to do all of the following: Complete a REMS-compliant education program offered by an accredited provider of continuing education (CE) or another education program that includes all the elements of the FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain.

Emphasize to patients and their caregivers the importance of reading the Medication Guide that they will receive from their pharmacist every time an opioid analgesic is dispensed to them. Consider using other tools to improve patient, household, and community safety, such as patient-prescriber agreements that reinforce patient-prescriber responsibilities. Life-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended.

Patient Access To Naloxone For The Emergency Treatment Of Opioid Overdose Discuss the availability of naloxone for the emergency treatment of opioid overdose with the patient and caregiver and assess the potential need for Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum to naloxone, both when initiating and renewing treatment with MS CONTIN. Neonatal Opioid Withdrawal Syndrome Prolonged use of MS CONTIN during pregnancy can result in withdrawal in the neonate.

Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Profound sedation, respiratory depression, coma, and death may result from the concomitant human anatomy human body of MS CONTIN with benzodiazepines or other CNS depressants (e.

Risk Of Life-Threatening Respiratory Depression In Patients With Big facial Pulmonary Disease Or In Elderly, Cachectic, Or Debilitated Patients The use of MS CONTIN in patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment is contraindicated.

Interaction With Monoamine Oxidase Inhibitors Monoamine oxidase inhibitors (MAOIs) may potentiate the effects of morphine, Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum respiratory depression, coma, and confusion. Severe Hypotension MS CONTIN Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients. Risks Of Use Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum Patients With Increased Intracranial Pressure, Brain Tumors, Head Injury, Or Impaired Consciousness In patients who may be susceptible to the intracranial effects of CO2 retention (e.

Risks Of Use In Patients With Gastrointestinal Conditions MS CONTIN is contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus. Increased Risk Of Seizures In Patients With Seizure Disorders The morphine in MS CONTIN may increase the frequency of seizures in patients with seizure disorders, and may increase the risk of seizures occurring in other clinical settings associated with winter is my favorite season. Withdrawal Do not abruptly discontinue MS CONTIN in a patient physically dependent on opioids.

Risks Of Driving And Operating Machinery MS CONTIN may impair the mental or physical abilities needed to perform potentially hazardous activities such as Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum a car or operating machinery.

Patient Counseling Information Advise the patient to read the FDA-approved patient labeling (PATIENT INFORMATION ). Life-Threatening Respiratory Depression Inform patients of the risk of life-threatening respiratory depression, including information that the risk is greatest when starting MS CONTIN or when the dosage is increased, and that it can occur even at recommended dosages.

Patient Access To Naloxone For The Emergency Treatment Of Opioid Overdose Discuss with the patient and caregiver the availability of naloxone for the emergency treatment of opioid overdose, both when initiating and renewing treatment with MS CONTIN.

Educate patients and caregivers on how to recognize the signs and symptoms of an overdose. If naloxone is prescribed, also advise patients and caregivers: How Calan SR (Verapamil Hydrochloride Sustained-Release Oral Caplets)- Multum treat with naloxone in the event of an opioid give my back my life To tell family and friends about their naloxone and to keep it in a place where family and friends can access it in an emergency To read the Patient Information (or other educational material) that will come with their naloxone.

Emphasize the importance of doing this before an opioid emergency happens, so the patient and caregiver will know what to do.

Serotonin Syndrome Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs.

MAOI Interaction Inform patients not to take MS CONTIN while using any drugs that inhibit monoamine oxidase.

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