The medication is a Schedule II drug.
Brand Names: MS Contin, Avinza, Kadian
Generic Available
Common Dosage Forms:
Tablets (MS Contin): 15 mg, 30 mg, 60 mg, 100 mg, 200 mg
Capsules (Avinza): 30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120 mg
Capsules (Kadian): 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 80 mg, 100 mg, 130 mg, 150 mg, 200 mg
*100 mg and above doses are for opioid-tolerant patients only
FDA Indications/Dosages:
For the relief of moderate to severe pain for use in patients who require repeated dosing with potent opioid analgesics over periods of more than a few days*: 15-400 mg daily in a single (capsule) or divided (tablet) dose.
Conversion from immediate-release oral morphine to extended-release morphine: Either administer one-half of the patient’s 24-hour requirement as an extended-release tablet on an every 12-hour schedule or administer one-third of the patient’s daily requirement on an every 8-hour schedule.
Conversion from parenteral morphine or other opioids, parenteral or oral, to extended-release morphine: Estimates of the relative potency of opioids are only approximate and are influenced by route of administration, individual patient difference, and possibly, by an individual’s medical condition. Consequently, it is difficult to recommend any fixed rule for converting a patient to extended-release morphine directly. For morphine, it is suggested that the oral morphine dosage only three times the daily parenteral morphine requirement in chronic use settings. For other parenteral or other oral opioids, physicians are advised to refer to published relative potency data, keeping in mind that such ratios are only approximate. In general, it is safer to underestimate the daily dose of extended-release morphine required and rely upon ad hoc supplementation to deal with inadequate analgesia. The 200 mg tablet is for use only in opioid tolerant patients requiring daily morphine equivalent dosage of 400 mg or more.
*Because it may be more difficult to titrate a patient using controlled-release morphine, it is advised to begin treatment using an immediate-release morphine formulation.
Pharmacology/Pharmacokinetics: Morphine produces analgesia by a central action on the central opiate receptors. Following an oral administration of a given dose of morphine, the amount ultimately absorbed is essentially the same whether the source is an extended-release or a conventional formulation. Morphine usually has an onset of action between 15-60 minutes, with a peak occurring between 30-60 minutes. The terminal elimination half-life of morphine is normally 2-4 hours. The elimination of morphine occurs primarily as renal excretion of 3-morphine glucuronide. A small amount of the glucuronide conjugate is excreted in the bile, and there is some minor enterohepatic recycling.
Drug Interactions: May enhance the actions of phenothiazine, general anesthetics, sedatives, hypnotics, alcohol, skeletal muscle relaxants, and agonist/antagonist analgesics. If testing for enzyme levels, narcotics may increase biliary tract pressure and subsequently increase amylase or lipase levels.
Contraindications/Precautions: Contraindicated on patients with respiratory depression in the absence of resuscitative equipment, and in patients with acute or severe bronchial asthma. Extended-release forms are contraindicated in any patient who has or is suspected of having paralytic ileus. Use with caution in patients with problems in blood pressure, head injury, severe hepatic or renal impairment, Addison’s disease, hypoparathyroidism, prostatic hypertrophy or urethral stricture, supraventricular tachycardia, seizure disorders, acute abdominal conditions, in pregnancy or lactation, and in asthma, or other respiratory-compromising conditions. OPIOIDS CAN BE ADDICTIVE, ABUSED, AND MISUSED WHICH CAN LEAD TO OVERDOSE AND DEATH. SERIOUS, LIFE-THREATENING RESPIRATORY DEPRESSION MAY OCCUR. ACCIDENTAL EXPOSURE CAN BE FATAL, ESPECIALLY IN CHILDREN. USE IN PREGNANCY CAN CAUSE NEONATAL WITHDRAWAL SYNDROME. CONCOMITANT USE WITH BENZODIAZEPINES, ALCOHOL, OR OTHER CNS DEPRESSANTS CAN RESULT IN RESPIRATORY DEPRESSION, COMA, AND DEATH. Pregnancy Category C.
Adverse Effects: Constipation, lightheadedness, dizziness, sedation, nausea, vomiting, sweating, dysphoria, and euphoria.
Patient Consultation:
Tablets must be taken whole, and are not to be broken, chewed, or crushed. Taken broken, chewed, or crushed extended-release formulations could lead to rapid release and absorption of a potentially toxic dose of morphine.
May cause drowsiness. Use caution while operating machinery or when mental alertness is required.
May take with food or milk to avoid GI upset.
WARNING: This medication may be habit-forming.
The prescription cannot be refilled.
Store in a cool, dry place away from sunlight and children.
Contact a physician if the above side effects are severe or persistent.
If a dose is missed, take it as soon as possible and reschedule your remaining doses based upon the schedule your physician prescribed. Do not double doses.
