Select a medication above to begin.
MS Contin
morphine sulfate
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about ER opioid use and how to mitigate assoc. risks; reserve ER forms for pts w/ inadequate tx alternatives; not indicated for prn analgesic use; proper dosing and titration essential to decr. resp. depression risk
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately; instruct pts to swallow tabs whole; crushing, dissolving, or chewing tabs can cause rapid release and absorption of potentially fatal morphine dose
Accidental Ingestion
accidental ingestion of even one dose, esp. by children, can result in fatal morphine overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
Adult Dosing .
Dosage forms: ER TAB: 15 mg, 30 mg, 60 mg, 100 mg, 200 mg
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
- [formulation clarification]
- Info: not bioequivalent w/ Kadian; do not substitute on a mg to mg basis
pain, mod-severe chronic
- [opioid-naive pts]
- Dose: individualize dose PO q8-12h; Start: 15 mg PO q8-12h, may incr. dose q1-2 days; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; do not cut/crush/chew/dissolve tab; >60 mg/dose, >120 mg/day, 100 mg tab, 200 mg tab for use in opioid-tolerant pts only; taper total daily dose by no more than 10-25% q2-4wk to D/C if long-term use
- [opioid-nontolerant pts]
- Dose: individualize dose PO q8-12h; Start: 15 mg PO q12h, may incr. dose q1-2 days; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older; do not cut/crush/chew/dissolve tab; >60 mg/dose, >120 mg/day, 100 mg tab, 200 mg tab for use in opioid-tolerant pts only; taper total daily dose by no more than 10-25% q2-4wk to D/C if long-term use
- [opioid-tolerant pts]
- Dose: individualize dose PO q8-12h; Start: individualize based on current opioid intake, see pkg insert for conversion; Info: use lowest effective dose, shortest effective tx duration; may incr. dose q1-2 days; consider low start dose, titrate slowly in pts 65 yo and older; do not cut/crush/chew/dissolve tab; taper total daily dose by no more than 10-25% q2-4wk to D/C if long-term use
renal dosing
- [see below]
- CrCl 10-50: decr. usual dose by 25%, titrate slowly; CrCl <10: avoid use
- HD/PD: avoid use
hepatic dosing
- [see below]
- cirrhosis: decr. usual start dose, amount not defined; Info: titrate slowly
Peds Dosing .
- Dosage forms: ER TAB: 15 mg, 30 mg, 60 mg, 100 mg, 200 mg
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, mod-severe chronic (off-label)
- [0.3-0.6 mg/kg/dose PO q12h]
- Start: individualize dose based on current opioid intake; Info: use lowest effective dose, shortest effective tx duration; do not crush/chew/dissolve tab; 100 mg tab, 200 mg tab for use in opioid-tolerant pts only; taper dose gradually to D/C
renal dosing
- [adjust dose amount]
- CrCl 10-50: decr. usual dose by 25%; CrCl <10: decr. usual dose by 50%; Info: titrate slowly
- HD: decr. usual dose by 50%; supplement after dialysis not defined; PD: decr. usual dose by 50%; supplement not defined; Info: titrate slowly
hepatic dosing
- [see below]
- cirrhosis: decr. usual start dose, amount not defined; Info: titrate slowly