Drug General Information (ID: DDI9G1MNIP)
  Drug Name Morphine (liposomal) Drug Info Ondansetron Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Analgesics Antiemetics
  Structure

 Mechanism of Morphine (liposomal)-Ondansetron Interaction (Severity Level: Moderate)
     Additive CNS depression effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Morphine (liposomal) Ondansetron
      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 Ondansetron 
     Additive serotonergic effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Morphine (liposomal) Ondansetron
      Mechanism 2 Serotonergic effects Serotonergic effects
      Key Mechanism Factor 2
Factor Name Serotonergic effects
Factor Description Serotonergic drugs include a variety of drugs that enhance or mimic the effects of the neurotransmitter serotonin. Excessive serotonergic activation may lead to a condition known as serotonin syndrome, in which high levels of serotonin in the brain cause the following symptoms: changes in blood pressure, coma, fever, increased heart rate, hallucinations, nausea, and seizures.
      Mechanism Description
  • Additive serotonergic effects by the combination of Morphine (liposomal) and Ondansetron 

Recommended Action
      Management Caution is advised when opioids are used concomitantly with serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), other antidepressants/psychotropic agents (e.g., amoxapine, buspirone, lithium, maprotiline, mirtazepine, nefazodone, trazodone, vilazodone), 5-HT1 receptor agonists (triptans), 5-HT3 receptor antagonists, cyclobenzaprine, dextromethorphan, 5-hydroxytryptophan, and St. John's wort. Patients should be monitored for symptoms of the serotonin syndrome during treatment. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary.

References
1 Vizcaychipi MP, Walker S, Palazzo M "Serotonin syndrome triggered by tramadol." Br J Anaesth 99 (2007): 919. [PMID: 18006535]
2 Mittino D, Mula M, Monaco F "Serotonin syndrome associated with tramadol-sertraline coadministration." Clin Neuropharmacol 27 (2004): 150-1. [PMID: 15190240]
3 Das PK, Warkentin DI, Hewko R, Forrest DL "Serotonin syndrome after concomitant treatment with linezolid and meperidine." Clin Infect Dis 46 (2008): 264-5. [PMID: 18171260]