Morphine
Drug Name | Form | Strength | Formulary Unrestricted | Formulary Restricted | Non-Formulary | Interchange |
---|---|---|---|---|---|---|
Kadian | CAPSULE, EXTENDED RELEASE, ORAL | 10 mg/24 hours, 20 mg/24 hours, 30 mg/24 hours, 50 mg/24 hours | ||||
AVINza | CAPSULE, EXTENDED RELEASE, ORAL | 30 mg/24 hours, 45 mg/24 hours, 60 mg/24 hours | ||||
AVINza | CAPSULE, EXTENDED RELEASE, ORAL | 75 mg/24 hours, 90 mg/24 hours, 120 mg/24 hours | ||||
Kadian | CAPSULE, EXTENDED RELEASE, ORAL | 80 mg/24 hours, 100 mg/24 hours, 200 mg/24 hours | ||||
Roxanol | CONCENTRATE, ORAL | 20 mg/mL | ||||
Astramorph, Duramorph | SOLUTION, INJECTABLE | 0.5 mg/mL preservative-free, 1 mg/mL preservative-free | ||||
moprhine | SOLUTION, INJECTABLE | 1 mg/mL, 2 mg/mL, 4 mg/mL, 8 mg/mL,10 mg/mL, 15 mg/mL | ||||
Infumorph | SOLUTION, INJECTABLE | 25 mg/mL preservative-free | ||||
morphine | SOLUTION, ORAL | 10 mg/5 mL | ||||
morphine | SUPPOSITORY, RECTAL | 10 mg | ||||
Arymo ER | TABLET, EXTENDED RELEASE, ORAL | 15 mg, 30 mg, 60 mg | ||||
MS Contin, Oramorph SR | TABLET, EXTENDED RELEASE, ORAL | 15 mg/12 hours, 30 mg/12 hours, 60 mg/12 hours | ||||
MS Contin, Oramorph SR | TABLET, EXTENDED RELEASE, ORAL | 100 mg/12 hours, 200 mg/12 hours | ||||
morphine | TABLET, ORAL | 15 mg, 30 mg |
Morphine sulfate oral CONCENTRATE (ROXANOL) 20 mg/mL is FORMULARY RESTRICTED to ADULT patients requiring at least 2 mg per dose AND unable to swallow/tolerate the volume of 2 mg/mL oral solution required for the needed dose. Safety precautions are in place to prevent mix-ups with other morphine products.
Safety measures for ROXANOL include:
1. Doses are ordered in amounts that can be fulfilled using a pre-filled oral syringe or a combination of pre-filled oral syringes. The nurse should not need to manipulate the amount of drug in a syringe.
2. Doses are ordered in mg rather than mL.
3. Morphine oral CONCENTRATE is dispensed in pre-filled oral syringes (2 mg, 5 mg, 10 mg, or 20 mg)
4. Morphine oral CONCENTRATE syringes are dispensed from PYXIS through the PYXIS profile and are not available on override.
KADIAN and AVINza both have a warning about an alcohol interaction that interferes with the sustained-release mechanism of the drug, thus too much morphine could be released in a short period of time, causing a serious ADE. Some liquid medications contain alcohol. Therefore, KADIAN and AVINza should not be ordered, stocked, or dispensed. [See Formulary Document for specific interchanges for KADIAN and AVINza (Table 1)]
AYRMO ER is non-formulary. Orders for AYRMO ER will be changed to MS CONTIN BID or TID on a 1 mg to 1 mg ratio at same dosing interval.
Ayrmo ER Medication Guide
AVINza medication guide
Embeda medication guide
Kadian medication guide
morphine oral solution medication guide
MS Contin medication guide
comfort care (opioid-naive) morphine drip protocol
Reviewed: March 27, 2012, February 26, 2013 (morphine sulfate oral CONCENTRATE), and 23 May 2017 (Arymo ER)
Updated: July 17, 2018 (moprhine CONCENTRATE - Adults only), March 24, 2020 (2 mg CONCENTRATE dose added)
REMS (Arymo ER, AVINza, Kadian, MS Contin): View FDA REMS Info