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|Covidien’s Mallinckrodt Business Launches Morphine Sulfate Oral Solution in U.S.|
Pain reliever now available for opioid-tolerant patients
“Pain is associated with a wide range of injury and disease, and
Morphine sulfate oral solution has been used to manage pain for many
“Mallinckrodt has a long history of working with regulators like the
The product is being launched with new packaging, including a plastic syringe dispenser with stopper that helps prevent spills. The plastic bottle also includes a view strip, and the product remains tinted blue to assist in identifying the amount in the bottle.
Morphine sulfate oral solution 100 mg per 5 mL (20 mg/mL) is an opioid analgesic indicated for the relief of moderate to severe acute and chronic pain in opioid-tolerant patients.
IMPORTANT RISK INFORMATION
Morphine sulfate oral solution 100 mg per 5 mL (20 mg/mL) is contraindicated in:
Morphine sulfate oral solution 100 mg per 5 mL (20 mg/mL) may cause fatal respiratory depression when administered to patients not previously exposed to opioids.
Patients considered to be opioid tolerant are those who are taking at least 60 mg oral morphine per day, or at least 30 mg of oral oxycodone per day, or at least 12 mg hydromorphone per day, or an equianalgesic dose of another opioid, for a week or longer.
For ORAL use only.
Always use the enclosed calibrated oral syringe when administering morphine sulfate oral solution 100 mg per 5 mL (20 mg/mL) to ensure the dose is measured and administered accurately.
Respiratory depression is the primary risk of morphine sulfate. Respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may significantly decrease pulmonary ventilation.
Use with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale and in patients having a substantially decreased respiratory reserve (e.g., severe kyphoscoliosis), hypoxia, hypercapnia, or preexisting respiratory depression. In such patients, even usual therapeutic doses of morphine sulfate may increase airway resistance and decrease respiratory drive to the point of apnea. Consider alternative non-opioid analgesics, and use morphine sulfate only under careful medical supervision at the lowest effective dose in such patients.
Morphine sulfate is an opioid agonist and a Schedule II controlled substance. Such drugs are sought by drug abusers and people with addiction disorders. Diversion of Schedule II products is an act subject to criminal penalty.
Morphine sulfate can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing morphine sulfate in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.
Do not use with alcohol and use caution with other medications that cause CNS or respiratory depression.
In the presence of increased intracranial pressure, the possible respiratory depressant effects and its potential to elevate cerebrospinal fluid pressure may be markedly exaggerated.
The effects on pupillary response and consciousness, which may obscure neurologic signs of further increases in intracranial pressure in patients with head injuries should be considered in such patients.
May obscure the diagnosis or clinical course in patients with acute abdominal condition.
Use with caution and in reduced dosages in patients with severe renal or hepatic impairment, Addison’s disease, hypothyroidism, prostatic hypertrophy, or urethral stricture, and in elderly or debilitated patients.
Exercise caution in the administration of morphine sulfate to patients with CNS depression, toxic psychosis, acute alcoholism and delirium tremens.
All opioids may aggravate convulsions in patients with convulsive disorders, and all opioids may induce or aggravate seizures in some clinical settings.
Caution patients about the potential for impairment of mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery.
Serious adverse reactions associated with morphine sulfate use include: respiratory depression, apnea, and to a lesser degree, circulatory depression, respiratory arrest, shock, cardiac arrest and death.
The most common adverse events are constipation, nausea, and somnolence. Other commonly observed adverse reactions include: lightheadedness, dizziness, sedation, vomiting, and sweating. The frequency of these events depends upon several factors including clinical setting, the patient’s level of opioid tolerance, and host factors specific to the individual. Anticipate and manage these events as part of opioid analgesia therapy.
Not intended for use in pregnancy or lactation. The safety and effectiveness in patients less than 18 years has not been established.
Physical dependence and tolerance are not unusual during chronic opioid therapy. Do not abruptly discontinue as withdrawal syndrome will likely be initiated.