Morphine Injection and Ticagrelor: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ticagrelor
Morphine Injection
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased morphine exposure and reduced absorption of ticagrelor
Interaction Deep Dive
Concomitant use of morphine (P-gp substrate) and ticagrelor (a P-gp inhibitor) may increase the exposure of morphine and increase the risk of morphine-related adverse effects. If coadministration is required, monitor for signs of respiratory and CNS depression1. Additionally, coadministration of ticagrelor with morphine delays and reduces the absorption of ticagrelor, presumably because of slowed gastric emptying, resulting in reduced exposure to ticagrelor metabolites. Consider the use of a parenteral antiplatelet agent in acute coronary syndrome patients requiring coadministration of morphine or other opioid agonists 2. In a retrospective study, in patients with ST-segment elevation myocardial infarction (STEMI) treated with ticagrelor, more patients coadministered morphine had a composite endpoint of death/myocardial infarction/urgent revascularization/definite acute stent thrombosis/bail-out use of GP IIb/IIIa inhibitors, and had more major bleeding within the first 24 hours or life-threatening/fatal bleeding. This may be due to morphine altering both pharmacokinetic and pharmacodynamic ticagrelor properties causing a delay and attenuation of ticagrelor action in STEMI patients 3.
Why it happens (mechanism)
Inhibition of P-gp mediated efflux transport of morphine; slowed gastric emptying
Literature reports
2 reports — tap to read
a) In a retrospective study in patients with ST-segment elevation myocardial infarction (STEMI) treated with ticagrelor (N=1862), more patients coadministered morphine required bail-out use of glycoprotein (GP) IIb/IIIa inhibitors within 24 hours of the first loading dose (11.3% vs. 7.9%) and had a composite endpoint of death/myocardial infarction/urgent revascularization/definite acute stent thrombosis/bail-out use of GP IIb/IIIa inhibitors (12.7% vs 9.4%), and had more major bleeding within the first 24 hours (1.1% vs 0.1%) or life-threatening/fatal bleeding (1.3% vs 0.3%). This may be due to morphine altering both pharmacokinetic and pharmacodynamic ticagrelor properties causing a delay and attenuation of ticagrelor action in STEMI patients 3.
b) In a clinical study, coadministration of 5 mg intravenous morphine with 180 mg loading dose of ticagrelor decreased observed mean ticagrelor exposure by up to 25% in healthy adults and up to 36% in ACS patients undergoing PCI. Tmax was delayed by 1-2 hours. Exposure of the active metabolite decreased to a similar extent 2.
Common questions
Can I take Morphine Injection and Ticagrelor together?
Increased morphine exposure and reduced absorption of ticagrelor Always confirm with your pharmacist or prescriber before making any change.
How serious is the Morphine Injection and Ticagrelor interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Morphine Injection or Ticagrelor need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: Morphine sulfate oral solution, morphine sulfate oral solution. Hikma Pharmaceuticals USA Inc (per FDA), Berkeley Heights, NJ, 2023. DailyMed
- Product Information: BRILINTA(R) oral tablets, ticagrelor oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2024. DailyMed
- Lapostolle F, Van't Hof AW, Hamm CW, et al: Morphine and ticagrelor interaction in primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: ATLANTIC-Morphine. Am J Cardiovasc Drugs 2019; 19(2):173-183.
Keep reading about Ticagrelor
Keep reading about Morphine Injection
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