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morphine/naltrexone (Embeda)
Capsules containing extended-release morphine pellets with an inner core of the opioid antagonist naltrexone
Indications:
- analgesia for patients at risk of substance abuse
- prevents one type of abuse, crushing the capsule to get all the morphine as immediate release
Dosage:
- QD or BID dosing
- capsules can be opened & the pellets sprinkled on applesauce
- do NOT crush
Capsules:
- morphine 20 mg & naltrexone 0.8 mg
- morphine 30 mg & naltrexone 1.2 mg
- morphine 50 mg & naltrexone 2 mg
- morphine 60 mg & naltrexone 2.4 mg
- morphine 80 mg & naltrexone 3.2 mg
- morphine 100 mg & naltrexone 4 mg
Pharmacokinetics:
- swallowing the capsules whole slowly releases just the morphine, but if the pellets are crushed, the naltrexone is released & can blunt morphine's effects
Adverse effects:
- constipation (31%)
- nausea (22%)
- vomiting (8%)
- sleepiness (7%)
- headache (7%)
- itching (6%)
- dizziness (4%)
- fatigue (4%)
Drug interactions:
- see morphine
Notes: costs $250 to $850 for 60 caps (2009)
General
pharmacologic combination
References
- Prescriber's Letter 16(10): 2009
New Drug: Embeda (Morphine/Naltrexone)
Detail-Document#: 251009
(subscription needed) http://www.prescribersletter.com
- FDA News Release. October 17, 2014
FDA approves labeling with abuse-deterrent features for third
extended-release opioid analgesic
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm419288.htm
- EMBEDA Prescribing Information
http://labeling.pfizer.com/ShowLabeling.aspx?id=694