Drug General Information (ID: DDI3TXWUVP)
Drug Name			Morphine (liposomal)		Drug Info		Metoclopramide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Antiemetics
Structure

Mechanism of Morphine (liposomal)-Metoclopramide Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Morphine (liposomal)				Metoclopramide
Mechanism 1		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Morphine (liposomal) and Metoclopramide
Antagonize the effect of prokinetic agents Click to Show/Hide Mechanism Graph
Drug Name		Morphine (liposomal)				Metoclopramide
Mechanism 2		Decrease gastrointestinal motility				Increase gastrointestinal motility
Key Mechanism Factor 2
		Factor Name		Prokinetic agents
		Factor Description		The efficacy of prokinetic agents may be reduced, leading to delayed gastric emptying and worsening esophageal reflux.
Mechanism Description		Antagonize the effect of Metoclopramide when combined with Morphine (liposomal)

Recommended Action
Management		The potential for reduced efficacy of gastrokinetic agents should be considered during coadministration with opioid analgesics. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their doctor if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References
1	Manara AR, Shelly MP, Quinn K, Park GR "The effect of metoclopramide on the absorption of oral controlled release morphine." Br J Clin Pharmacol 25 (1988): 518-21. [PMID: 3382595]
2	Product Information. Reglan (metoclopramide). Wyeth-Ayerst Laboratories, Philadelphia, PA.
3	Greiff JMC, Rowbotham D "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet 27 (1994): 447-61. [PMID: 7882635]