- Morphine sulfate is an opioid agonist and a schedule II controlled substance having liability for abuse. Strongly consider this when prescribing or dispensing in situations where physician/pharmacist is concerned about an increased risk of misuse abuse or diversion
- Patients not already tolerant to high doses of opioids are prone to fatal respiratory depression on ingestion of these capsules or the pellets within the capsules
- Take utmost care to avoid dosing errors due to confusion between different concentrations and between mg and mL, which could result in accidental overdose and death
- Accidental ingestion of morphine may result in fatal overdose, especially in children
- Store morphine oral solution out of the reach of children
Black Box Warning for all sustained release morphine preparations
- Abuse potential must be considered when prescribing
- Sustained release formulations are indicated for around the clock opioid analgesia which is expected to be needed for an extended period of time
- These formulations are not indicated as a prn analgesic
- Larger dose formulations (e.g.
100 mg sustained release) are for use in opioid tolerant patients only
Black Box Warning for Avinza
- Avinza capsules are to be swallowed whole or the contents sprinkled on applesauce. The capsule beads must not be chewed, crushed, or dissolved due to the risk of rapid release and absorption of a potentially fatal dose of morphine. Patients must not consume alcoholic beverages while on Avinza (or use OTC or Rx medications with alcohol in them). Consumption of alcohol while taking Avinza may result in the rapid release and absorption of a potentially fatal dose of morphine.
Black Box Warning for Kadian
- Kadian capsules are to be swallowed whole or the contents sprinkled on applesauce. The capsule beads must not be chewed, crushed, or dissolved due to the risk of rapid release and absorption of a potentially fatal dose of morphine.
Black Box Warning for MS Contin/Oramorph SR
- Tablets are to be swallowed whole and must not be cut, crushed, chewed or dissolved due to the risk of rapid release and absorption of a potentially fatal dose of morphine
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Reduce dose by 25%
- <10 mL/min: Reduce dose by 50%
Hepatic Dose Adjustment
- Severe hepatic impairment: Dose reduction recommended but not specified
See Supplemental Patient Information
- Swallow sustained release capsules whole or sprinkle the contents of the capsules on applesauce. Avoid chewing/crushing/dissolving capsule beads due to the risk of rapid release and absorption of a potentially fatal dose of morphine [US Black Box Warning]
- Limit the daily dose of Avinza to a maximum of 1600 mg/day. Doses >1600 mg/day contain a quantity of fumaric acid that has not been demonstrated to be safe, and may result in serious renal toxicity
- Advise patients to avoid consuming alcoholic beverages while undergoing therapy. Additionally, advise patients to avoid using prescription or non-prescription medications containing alcohol while undergoing therapy
- 100, 200 mg capsules of Kadian, MS contin and 100 mg per 5 mL (20 mg/mL) concentration are for use in opioid tolerant patients only. Fatal respiratory depression has occurred on administration to patients not previously exposed to opioids [US Black Box Warning]
- Instruct patients against use by individuals other than the patient for whom the dose is prescribed, as such inappropriate use may have severe medical consequences, including death
- Morphine sulfate is an opioid agonist and a schedule II controlled substance having liability for abuse. Morphine and other opioids used for analgesia can be abused and are subject to criminal diversion [US Black Box Warning]. Strongly consider this when prescribing or dispensing in situations where physician/pharmacist is concerned about an increased risk of misuse abuse or diversion. Contact their state professional licensing board, or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product. Carefully keep record of prescribing information, including quantity, frequency, and renewal requests. Properly assess patients and prescribe medications, periodically re-evaluate therapy, and carefully dispense and store the formulation to limit abuse of opioid drugs
- Abuse of the crushed formulation poses a hazard of overdose and death. Risk is increased with concurrent abuse of alcohol and other substances. Local tissue necrosis, infection, pulmonary granulomas, increased risk of endocarditis and valvular heart injury has occurred due to the parenteral abuse of the talc as one of the excipients in tablets. Parenteral drug abuse is associated with transmission of infectious diseases such as hepatitis and HIV
- Respiratory depression, hypotension, and profound sedation or coma have occurred on using in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression
- Elderly and debilitated patients, as well as those suffering from conditions accompanied by hypoxia or hypercapnia even with moderate therapeutic doses are prone to respiratory depression
- Even usual therapeutic doses of morphine may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea in patients with manifestations of respiratory system
- Respiratory depressant effects of morphine with carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure are markedly exaggerated in the presence of head injury, other intracranial lesions, or pre-existing increase in intracranial pressure
- Patients with depleted blood volume, or using drugs such as phenothiazines or general anesthetics concurrently, are prone to severe hypotension. Orthostatic hypotension has occurred in ambulatory patients
- Rare cases of anaphylaxis have occurred
- Obscures the diagnosis or clinical course in patients with acute abdominal conditions
- Aggravation of convulsions in patients with convulsive disorders has occurred
- Mixed agonist/antagonist analgesics reduce the analgesic effect of morphine sulfate and/or precipitate withdrawal symptoms in these patients
- Abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist results in physical dependence
- Discontinue Kadian therapy 24 hrs prior to cordotomy. The post-procedure titration of analgesics should be individualized to avoid either oversedation or withdrawal syndromes
- Opioid abstinence or withdrawal syndrome is characterized by restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, piloerection, myalgia, mydriasis, irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate
Cautions: Use cautiously in:
- Renal impairment
- Hepatic impairment
- Pulmonary impairment
- COPD
- Cor pulmonale
- Decreased respiratory reserve
- Hypoxia
- Hypercapnia
- Pre-existing respiratory depression
- Circulatory shock
- Coma
- CNS depression
- Head injury
- Intracranial lesion
- ICP increased
- Seizure disorder
- Abuse
- Acute alcoholism
- Delirium tremens
- Toxic psychosis
- Delirium tremens
- Kyphoscoliosis
- Adrenocortical insufficiency
- Adrenal insufficiency (e.g. Addison's Disease)
- Myxedema
- Hypothyroidism
- Toxic psychosis
- Prostatic hypertrophy
- Patients undergoing surgery of the biliary tract
- Urethral stricture
- Acute alcoholism
- Acute abdomen
- Acute pancreatitis or biliary disease
- Inability to swallow
- Patients who are concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, other tranquilizers, and alcohol
- Geriatrics
- Debilitated patients
Supplemental Patient Information
- Caution patients that the therapy could impair the mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery
- Caution patients about the potential effects of morphine sulfate on concomitant use with other CNS depressants, including other opioids, phenothiazines, sedative/hypnotics and alcohol
Pregnancy Category:C
Breastfeeding: Oral doses of maternal morphine in the immediate postpartum period result in higher milk levels than with epidural morphine; however, these levels are quite low. It is best to limit maternal parenteral morphine dosage and to supplement analgesia with a nonnarcotic analgesic if mother's milk comes in. If the baby shows signs of increased sleepiness (more than usual), difficulty in breastfeeding, breathing difficulties, or limpness, immediately contact a physician. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 27 January 2011). Manufacturer advises to consider a decision for discontinuing nursing or discontinue therapy taking into account the importance of the drug to the mother.
US Trade Name(s)
- Avinza
- Kadian
- MS Contin
- Oramorph SR (Discontinued)
US Availability
morphine (generic)
- TABS: 15, 30 mg
- ETABS: 15, 30, 60, 100, 200 mg
- ECAPS: 10, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120 mg
- SOLN: 10 mg/5 mL
- SOLN: 20 mg/5 mL
- SOLN: 100 mg/5 mL
Avinza (for q24 hrs dosing)
- ECAPS: 30, 45, 60, 75, 90, 120 mg
Kadian (for q12-24 hrs dosing)
- ECAPS: 10, 20, 30, 40, 50, 60, 70, 80, 100, 130, 150, 200 mg
MS Contin (for q8-12 hrs dosing)
- ETABS: 15, 30, 60, 100, 200 mg
Oramorph SR (for q8-12 hrs dosing)
- ETABS: 15, 30, 60, 100 mg
Canadian Trade Name(s)
- Doloral
- Doloral 5 sirop
- Kadian
- M-Eslon
- M.O.S. 10
- M.O.S. 20
- M.O.S. 40
- M.O.S. 50
- M.O.S. 60
- M.O.S.-S.R
- M.O.S. sulphate
- M.O.S.
- MS contin
- MS-IR
- Statex
Canadian Availability
morphine (generic)
- ETABS: 15, 30, 60, 100, 200 mg
- SYRUP: 1 mg/mL
- SYRUP: 5 mg/mL
- SYRUP: 10 mg/mL
- SYRUP: 20 mg/mL
Doloral
Doloral 5 sirop
Kadian (for q24 hrs dosing)
- ECAPS: 10, 20, 50, 100 mg
M-Eslon (for q12 hrs dosing)
- ECAPS: 10, 15, 30, 60, 100, 200 mg
M.O.S. 10
- TABS: 10 mg
- SYRUP: 10 mg/mL
M.O.S. 20
- TABS: 20 mg
- SYRUP: 20 mg/mL
M.O.S. 40
M.O.S. 50
M.O.S. 60
M.O.S.-S.R (for q12 hrs dosing)
M.O.S. sulphate
M.O.S.
- SYRUP:1 mg/mL
- SYRUP:5 mg/mL
MS contin (for q8-12 hrs dosing)
- ECAPS: 5, 15, 30, 60, 100, 200 mg
MS-IR
Statex
- TABS: 5, 10, 25, 50 mg
- SYRUP: 1 mg/mL
- SYRUP: 5 mg/mL
- SYRUP: 10 mg/mL
- DROPS: 20 mg/mL
- DROPS: 50 mg/mL
UK Trade Name(s)
- Morphgesic
- MST Continus
- MXL
- Oramorph
- Sevredol
- Zomorph
UK Availability
Morphgesic (for q12 hrs dosing)
- ETABS: 10, 30, 60, 100 mg
MST Continus ( for q12 hrs dosing)
- ETABS: 5, 10, 15, 30, 60, 100, 200 mg
- SUSP (in sachets): 20, 30, 60, 100, 200 mg
MXL (for q24 hrs dosing)
- ECAPS: 30, 60, 90, 120, 150, 200 mg
Oramorph
- SYRP: 10 mg/5 mL
- SYRP: 20 mg/mL
Sevredol
Zomorph
- CAPS: 10, 30, 60, 100, 200 mg
Australian Trade Name(s)
- Anamorph
- Kapanol
- Momex SR
- MS Contin
- MS Mono
- Sevredol
Australian Availability
Anamorph
Kapanol (for q12-24 hrs dosing)
Momex SR (for q8-12 hrs dosing)
- ETABS: 10, 30, 60, 100 mg
MS Contin (for q8-12 hrs dosing)
- ETABS: 5, 10, 15, 30, 60, 100, 200 mg
MS mono (for q24 hrs dosing)
Sevredol
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- MS Contin 100 MG TB12 [Bottle] (PURDUE PHARMA L.P.)
20 mg = $194.4
30 mg = $291.59 - AVINza 90 MG CP24 [Bottle] (KING PHARMA)
20 mg = $268
30 mg = $401.99 - MS Contin 15 MG TB12 [Bottle] (PURDUE PHARMA L.P.)
20 mg = $48.59
30 mg = $72.89 - Kadian 50 MG CP24 [Bottle] (ACTAVIS KADIAN)
20 mg = $203.99
30 mg = $305.96 - Kadian 60 MG CP24 [Bottle] (ACTAVIS KADIAN)
20 mg = $212.99
30 mg = $318.96 - AVINza 120 MG CP24 [Bottle] (KING PHARMA)
20 mg = $276
30 mg = $414 - Kadian 30 MG CP24 [Bottle] (ACTAVIS KADIAN)
20 mg = $118.98
30 mg = $178.97 - Kadian 20 MG CP24 [Bottle] (ACTAVIS KADIAN)
20 mg = $95.17
30 mg = $142.76 - AVINza 30 MG CP24 [Bottle] (KING PHARMA)
20 mg = $97.99
30 mg = $146.98 - Kadian 100 MG CP24 [Bottle] (ACTAVIS KADIAN)
20 mg = $338.58
30 mg = $507.88 - MS Contin 30 MG TB12 [Bottle] (PURDUE PHARMA L.P.)
20 mg = $74.51
30 mg = $111.77 - MS Contin 60 MG TB12 [Bottle] (PURDUE PHARMA L.P.)
20 mg = $132.83
30 mg = $199.24 - AVINza 60 MG CP24 [Bottle] (KING PHARMA)
20 mg = $182.99
30 mg = $274.49 - MS Contin 200 MG TB12 [Bottle] (PURDUE FREDERICK)
20 mg = $326.42
30 mg = $489.62
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
