MORPHINE sustained-release (MSR) oral

Prescription under medical supervision

Therapeutic action

– Centrally acting opioid analgesic

Indications

– Severe and persistent pain, especially cancer pain

Forms and strengths

– 10 mg, 30 mg and 60 mg sustained-release capsules or tablets

Dosage

– Usually, the effective daily dose is determined during the initial treatment with immediate-release morphine (MIR). When changing from MIR to MSR, the daily dose remains the same.
For example, if the effective dose of MIR is 20 mg every 4 hours (120 mg daily), the dose of MSR is 60 mg every 12 hours (120 mg daily).

– If treatment is initiated directly with MSR:
• Child over 6 months: initially 0.5 mg/kg every 12 hours
• Adult: initially 30 mg every 12 hours
Adjust the dose if necessary, increasing the dose by 50% per day until pain relief is obtained.

– Patients stabilized on MSR may require rescue doses of MIR in the event of episodic (breakthrough) pain. A rescue dose corresponds to 10% of the daily MSR dose. If a patient regularly requires more than 3 rescue doses per day, increase the daily MSR dose by the sum of rescue doses.

Duration

– According to clinical response. Do not stop long-term treatment abruptly. Decrease doses progressively to avoid withdrawal symptoms.

Contra-indications, adverse effects, precautions

– Do not administer to patients with severe respiratory impairment or decompensated hepatic impairment.
– Do not initiate treatment with the sustained-release formulation in elderly patients or those with renal or hepatic impairment. Begin treatment with the immediate release formulation (MIR).
– May cause:
• dose-related sedation and respiratory depression, nausea, vomiting, constipation, urinary retention, confusion, raised intracranial pressure, pruritus;
• in the event of overdose: excessive sedation, respiratory depression, coma.
– Management of respiratory depression includes assisted ventilation and/or administration of naloxone. Monitor patient closely for several hours.
– Administer with caution to patients with respiratory impairment, head injury, raised intracranial pressure, uncontrolled epilepsy or urethroprostatic disorders.
– Do not combine with opioid analgesics with mixed agonist-antagonist activity such as buprenorphine, nalbuphine, pentazocine (competitive action).
– Increased risk of sedation and respiratory depression, when combined with alcohol and drugs acting on the central nervous system: benzodiazepines (diazepam, etc.), neuroleptics (chlorpromazine, haloperidol, etc.), antihistamines (chlorphenamine, promethazine), phenobarbital, etc.
– Pregnancy and breast-feeding: no contra-indication. The child may develop withdrawal symptoms, respiratory depression and drowsiness when the mother receives morphine at the end of the 3rd trimester and during breast-feeding. In these situations, administer with caution, for a short period, at the lowest effective dose, and monitor the child.

Remarks

– Administer an appropriate laxative (e.g. lactulose) if analgesic treatment continues more than 48 hours.
– Do not crush or chew capsules. They can be opened and emptied into food.
– Morphine is on the list of narcotics: follow national regulations.
– Storage: below  25 °C -  -