Morphine and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Morphine
No brand names on recordCyclosporine 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 an increased risk of morphine-related adverse effects (hypotension, respiratory depression, profound sedation, coma)
Interaction Deep Dive
Concomitant use of a P-gp inhibitor, such as cycloSPORINE, and morphine may increase the exposure of morphine (approximately 2-fold) and increase the risk of adverse effects, including respiratory and CNS depression. If coadministration is required, monitor for signs of respiratory and CNS depression12345. Furthermore, there is an increasing incidence of transplant patients developing neurological complications from simultaneous administration of cycloSPORINE and morphine. It has been proposed that the intracellular hypercalcemic effect of cycloSPORINE may cause a decreased excitation of threshold of the nerve cell. This is thought to either amplify the dysphoric effect of morphine or cause neurological complications during the early post-transplant period 7.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of cycloSPORINE
Literature reports
1 report — tap to read
a) A case report describes a 45-year-old renal transplant patient who developed neurological symptoms during concomitant treatment with cycloSPORINE and morphine. A continuous infusion of cycloSPORINE was administered preoperatively and postoperatively. Patient controlled administration of morphine was used postoperatively. Three days postoperatively, the patient presented with insomnia, anxiety, amnesia, aphasia and severe confusion. The symptoms subsided with the use of propofol, diazePAM, haloperidol and the discontinuation of morphine. Oral cycloSPORINE replaced intravenous cycloSPORINE on the fourth day. Serum cycloSPORINE levels were maintained at 1.3 mg/dl with no recurrence of neurological symptoms 6.
Common questions
Can I take Morphine and Cyclosporine Injection together?
Increased morphine exposure and an increased risk of morphine-related adverse effects (hypotension, respiratory depression, profound sedation, coma) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Morphine and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Morphine or Cyclosporine Injection 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 (7)
- Product Information: AVINZA(R) oral extended release capsules, morphine sulfate oral extended release capsules. Pfizer Inc (per FDA), New York, NY, 2014. DailyMed
- Product Information: MS CONTIN(R) oral extended-release tablets, morphine sulfate oral extended-release tablets. Purdue Pharma LP (per FDA), Stamford, CT, 2023. DailyMed
- Product Information: KADIAN(R) oral extended-release capsules, morphine sulfate oral extended-release capsules. Allergan USA, Inc (per FDA), Madison, NJ, 2019. DailyMed
- Product Information: Morphine sulfate oral solution, morphine sulfate oral solution. Hikma Pharmaceuticals USA Inc (per FDA), Berkeley Heights, NJ, 2023. DailyMed
- Product Information: Morphine sulfate oral tablets, morphine sulfate oral tablets. Hikma Pharmaceuticals USA Inc.(Per FDA), Berkeley, NJ, 2023. DailyMed
- Lee P, Hung C, Lei H, et al: Suspected acute post-transplant neuropsychosis due to interaction of morphine and cyclosporin after a renal transplant. Anesthesia 2000; 55:827-828. PubMed
- Lee P, Hung C, Lei H, et al: Suspected acute post-transplant neurophsychosis due to interaction of morphine and cyclosporin after a renal transplant. Anesthesia 2000; 55:827-828.
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