Morphine with Tranylcypromine Interaction Details
Brand Names Associated with Morphine
- Arymo® ER
- Avinza®
- Embeda® (as a combination product containing Morphine, Naltrexone)
- Kadian®
- Morphabond®
- Morphine
- MS Contin®
- Oramorph® SR
- Roxanol-T
Brand Names Associated with Tranylcypromine
- Parnate®
- Transamine sulphate
- Tranylcypromine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 20, 2023
Interaction Effect
Potentiation of the CNS and respiratory depressant effects of morphine and increased risk of serotonin syndrome
Interaction Summary
The concurrent administration of morphine and MAOIs is not recommended. Allow at least 14 days to elapse after discontinuing an MAOI before administering morphine. Concomitant administration of MAOIs with morphine may result in potentiation of the CNS and respiratory depressant effects of morphine. However, it has been suggested that morphine is the narcotic analgesic of choice in patients receiving MAOIs and requiring emergency surgery . Serotonin syndrome has also been reported with concomitant use . If concomitant use is required or morphine administration is necessary prior to 14 days after discontinuing an MAOI, monitor the patient closely for signs and symptoms of CNS or respiratory depression .
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
The concurrent administration of morphine with MAOIs is not recommended because the effects of morphine may be potentiated. Allow a minimum of 14 days to elapse after discontinuing treatment with MAOIs before administering morphine. If concomitant use is required or morphine administration is necessary prior to 14 days after discontinuing an MAOI, monitor closely for signs and symptoms CNS or respiratory depression . Serotonin syndrome has also been reported with concomitant use .
Mechanism Of Interaction
Unknown; additive serotonergic effects
Literature Reports
A) In a case report, a 57-year-old woman that was well controlled on phenelzine for moderate depression presented to the hospital with signs and symptoms of serotonin syndrome. Ten days earlier, she was treated for cellulitis and received antiinfective agents, acetaminophen, and morphine sulfate oral solution. The patient was discharged after 7 days and then presented to the emergency department 3 days later with complaints of increasing visual hallucinations, restlessness, photophobia, dizziness, neck stiffness, occipital headache, sweating, and nausea for the last week. Morphine sulfate and phenelzine were stopped on admission and general supportive measures, including oxygen and fluids, were started. The patient was discharged 2 days later after full resolution of symptoms, and phenelzine was restarted on discharge without complications. The Drug Interaction Probability Scale (DIPS) indicated a probable relationship between phenelzine and morphine with a score of 6 .
Morphine Overview
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Morphine is used to relieve moderate to severe pain. Morphine extended-release tablets and capsules are only used to relieve severe (around-the-clock) pain that cannot be controlled by the use of other pain medications. Morphine extended-release tablets and capsules should not be used to treat pain that can be controlled by medication that is taken as needed. Morphine is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.
Tranylcypromine Overview
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Tranylcypromine is used to treat depression in people who have not been helped by other medications. Tranylcypromine is in a class of medications called monoamine oxidase inhibitors (MAOIs). It works by increasing the amounts of certain natural substances that are needed to maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.