MORPHABOND ER CII
Generic Name and Formulations:
Morphine sulfate 15mg, 30mg, 60mg, 100mg; ext-rel tabs.
Indications for MORPHABOND ER:
Management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
Limitations Of use:
Not for use as an as-needed (prn) analgesic. Use only if alternative treatment options (eg, non-opioid analgesics, immediate-release opioids) are ineffective, not tolerated, or otherwise inadequate to provide sufficient management of pain.
Use lowest effective dose for shortest duration. Swallow whole; do not crush, chew, or dissolve. Individualize. Opioid-naive or opioid non-tolerant: initially 15mg every 12hrs. May adjust dose every 1–2 days. Use 100mg tabs, a single dose >60mg, or a total daily dose >120mg in opioid-tolerant patients only. Renal failure, cirrhosis: initiate at lower dose; titrate slowly and monitor. Conversion from other morphine formulations or other opioids: see full labeling. Withdraw gradually by 25–50% every 2–4 days.
<18yrs: not established.
Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. During or within 14 days of MAOIs. Known or suspected GI obstruction, including paralytic ileus.
Addiction, abuse, and misuse. Life-threatening respiratory depression. Accidental ingestion. Neonatal opioid withdrawal syndrome. Risks from concomitant use with benzodiazepines or other CNS depressants.
Abuse potential (monitor). Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Accidental exposure may cause fatal overdose (esp. in children). COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Renal or hepatic impairment. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery, nursing mothers: not recommended.
See Contraindications. Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. May be potentiated by cimetidine, P-gp inhibitors (eg quinidine); monitor. May increase serum amylase.
Constipation, dizziness, sedation, nausea, vomiting, sweating, dysphoria, euphoria; respiratory depression, severe hypotension, syncope.
Neurology Advisor Articles
- Gender and Multiple Sclerosis: How It Influences Prognosis and Future Treatment
- Significant Variations in Epilepsy Surgical Strategy, Deficit Reporting Exist
- Thrombolysis With Tenecteplase Is as Safe as Alteplase in Stroke Mimics
- Loss of Function Variants in LRRK1 and LRRK2 Not Linked to Parkinson Disease
- Smoking Promotes Disease Progression in Multiple Sclerosis
- 5 Key Findings Presented at 2018 Parkinson Disease Conference
- Parkinson Disease and the Gut: Treatment Potential Abounds
- Managing Comorbid Migraine and Mood Disorders: A Synergistic Approach
- Stroke-Code Patients With Low NIHSS Score, No Acute Imaging Findings Often Misdiagnosed
- Ethical Challenges of Nusinersen: Considerations When Counseling on Treatment
- ZTlido Patch for Post-Shingles Pain Launching Soon
- Managing Complications of Intrathecal Baclofen Therapy
- Deep Brain Stimulation Reduces Tremor Symptoms in Parkinson Disease
- FDA Issues Statement Addressing Safety Concerns Associated With Nuplazid
- Prevalence of Autoimmune Encephalitis in Herpes Simplex Encephalitis Explored