Slow-release oral morphine - Revision history

Aidan: /* Contraindications */

2021-03-05T18:37:16Z

Contraindications

← Older revision		Revision as of 18:37, 5 March 2021
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	== Background ==		==Background==

	* Morphine sulphate sustained release capsules (Kadian)		*Morphine sulphate sustained release capsules (Kadian)
	** Beads contain both immediate release and slow release morphine		**Beads contain both immediate release and slow release morphine
	** IR released by stomach acid and SR released in bowels at higher pH		**IR released by stomach acid and SR released in bowels at higher pH
	** Capsules themselves may pass in the stool		**Capsules themselves may pass in the stool
	* Full opioid agonist		*Full opioid agonist
	* Approved for chronic pain, but used off-label for [[opioid use disorder]]		*Approved for chronic pain, but used off-label for [[opioid use disorder]]
	* Appears likely to be equivalent to [[methadone]], but higher patient satisfaction		*Appears likely to be equivalent to [[methadone]], but higher patient satisfaction
	* Peak plasma level 8.5 to 10 hours		*Peak plasma level 8.5 to 10 hours
	* Elimination half life 11 13 hours		*Elimination half life 11 13 hours

	==Dosing==		==Dosing==

	* For daily dispensed, often opened and sprinkled on apple sauce or yoghurt, or water		*For daily dispensed, often opened and sprinkled on apple sauce or yoghurt, or water
	* Capsule sizes include 10, 20, 50, and 100 mg		*Capsule sizes include 10, 20, 50, and 100 mg
	* Specify on the prescription if it is being used for OUD or chronic pain		*Specify on the prescription if it is being used for OUD or chronic pain

	===BC OUD Guidelines===		===BC OUD Guidelines===
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	\|}		\|}

	=== Off-Guideline ===		===Off-Guideline===

	* For induction from methadone or non-methadone opioids with high opioid tolerance		*For induction from methadone or non-methadone opioids with high opioid tolerance
	* Start at 200 to 300 mg, then increase by 100 to 150 q48h		*Start at 200 to 300 mg, then increase by 100 to 150 q48h
	* Missed days		*Missed days
	** 1: full		**1: full
	** 2: 50% reduction		**2: 50% reduction
	** 3: 75% reduction or resume at initiation dose		**3: 75% reduction or resume at initiation dose
	** 4: resume at initiation dose		**4: resume at initiation dose

	=== Carries ===		===Carries===

	* Per guidelines, doses should be indefinitely witness ingestion		*Per guidelines, doses should be indefinitely witness ingestion
	* However, may be reasonable to do same for [[methadone]]		*However, may be reasonable to do same for [[methadone]]
	** No carrier x 8 weeks, then one carry per week every month with weekly urine drug screens		**No carrier x 8 weeks, then one carry per week every month with weekly urine drug screens

	=== Switch to Methadone ===		===Switch to Methadone===

	* Must stop SROM and start [[methadone]] titration from 30 mg		*Must stop SROM and start [[methadone]] titration from 30 mg

	=== Switch to M-Eslon ===		===Switch to M-Eslon===

	* Split SROM dose for BID M-Eslon		*Split SROM dose for BID M-Eslon
	* Dosages include 10, 15, 30, 60, 100, and 200 mg		*Dosages include 10, 15, 30, 60, 100, and 200 mg

	== Safety ==		==Safety==

	* Adverse effects include GI cramping, abdominal pain, headache, hyperhidrosis, constipation, frequent urination, nausea/vomiting, and insomnia		*Adverse effects include GI cramping, abdominal pain, headache, hyperhidrosis, constipation, frequent urination, nausea/vomiting, and insomnia
	* Risk of respiratory depression and other forms of [[opioid toxicity]]		*Risk of respiratory depression and other forms of [[opioid toxicity]]
	* Safe in pregnancy		*Safe in pregnancy
	** Small RCT suggests no difference from [[methadone]] in neonatal outcomes but possibly lower unprescribed drug use in SROM		**Small RCT suggests no difference from [[methadone]] in neonatal outcomes but possibly lower unprescribed drug use in SROM

	=== Contraindications ===		===Contraindications===

	* Hypersensitivity to morphine		*Hypersensitivity to morphine
	* Respiratory		*Respiratory
	** Significant respiratory depression		**Significant respiratory depression
	** Acute or severe bronchial asthma		**Acute or severe bronchial [[asthma]]
	** Severe respiratory compromise or obstructive disease		**Severe respiratory compromise or obstructive disease
	* Gastrointestinal		*Gastrointestinal
	** Known or suspected paralytic ileus		**Known or suspected paralytic [[ileus]]
	** Short gut syndrome of transit time abnormalities		**[[Short gut syndrome]] of transit time abnormalities
			*Alcohol use, including intoxication and [[Alcohol withdrawal\|withdrawal]]
	* Alcohol use
	* MAOI use within 14 days		*MAOI use within 14 days

	[[Category:Medications]]		[[Category:Medications]]

Aidan at 01:07, 11 February 2021

2021-02-11T01:07:36Z

@@ Line 1: / Line 1: @@
-== Dosing ==
+== Background ==
 {| class="wikitable"
-! Number missed !! Action
+!Number missed!!Action
 |-
-| 1 || no change
+|1||no change
 |-
-| 2 || 40% reduction
+|2||40% reduction
 |-
-| 3 || 60% reduction
+|3||60% reduction
 |-
 |-
-| 5 || re-initiate
+|5||re-initiate
 |}
-=== St. Michael's Protocol ===
+===St. Michael's Protocol===
 {| class="wikitable"
-! Day !! Slow-release morphine      !! Instant-release morphine
+!Day!!Slow-release morphine!!Instant-release morphine
 |-
-| 1   || 200-300 mg                 || 30-50 mg po q2h while awake + 30-50 mg po q3h prn
+|1||200-300 mg||30-50 mg po q2h while awake + 30-50 mg po q3h prn
 |-
-| 2   || SR dose from Day 1 + 50% of IR dose from Day 3 || 30-50 mg po q2h while awake + 30-50 mg po q3h prn
+|2||SR dose from Day 1 + 50% of IR dose from Day 3||30-50 mg po q2h while awake + 30-50 mg po q3h prn
 |-
-| 3   || SR dose from Day 2         || 30-50 mg po q3h prn
+|3||SR dose from Day 2||30-50 mg po q3h prn
 |-
-| 4   || SR dose from Day 3 + 50% of IR dose from Day 3 || 30-50 mg po q3h prn
+|4||SR dose from Day 3 + 50% of IR dose from Day 3||30-50 mg po q3h prn
 |-
-| 5   || SR dose from Day 4         || 30-50 mg po q3h prn
+|5||SR dose from Day 4||30-50 mg po q3h prn
 |-
-| 6   || SR dose from Day 5 + 50% of IR dose from Day 5 || 30-50 mg po q3h prn
+|6||SR dose from Day 5 + 50% of IR dose from Day 5||30-50 mg po q3h prn
 |}
 [[Category:Medications]]

Aidan: Created page with "== Dosing == === BC OUD Guidelines === * Increase doses q48h * When transitioning from methadone, the eventual dose will usually be 6- to 8-times higher, but generally sho..."

2020-07-05T14:01:55Z

Created page with "== Dosing == === BC OUD Guidelines === * Increase doses q48h * When transitioning from methadone, the eventual dose will usually be 6- to 8-times higher, but generally sho..."

New page

== Dosing ==
=== BC OUD Guidelines ===
* Increase doses q48h
* When transitioning from [[methadone]], the eventual dose will usually be 6- to 8-times higher, but generally should start with a 4-times higher dose to be safe
* For other opioids, start with dose of 30 to 60 mg
* Average stable doses are 60 to 1200 mg daily

==== Missed doses ====
{| class="wikitable"
! Number missed !! Action
|-
| 1 || no change
|-
| 2 || 40% reduction
|-
| 3 || 60% reduction
|-
| 4 || 40 mg or starting dose
|-
| 5 || re-initiate
|}

=== St. Michael's Protocol ===
{| class="wikitable"
! Day !! Slow-release morphine !! Instant-release morphine
|-
| 1 || 200-300 mg || 30-50 mg po q2h while awake + 30-50 mg po q3h prn
|-
| 2 || SR dose from Day 1 + 50% of IR dose from Day 3 || 30-50 mg po q2h while awake + 30-50 mg po q3h prn
|-
| 3 || SR dose from Day 2 || 30-50 mg po q3h prn
|-
| 4 || SR dose from Day 3 + 50% of IR dose from Day 3 || 30-50 mg po q3h prn
|-
| 5 || SR dose from Day 4 || 30-50 mg po q3h prn
|-
| 6 || SR dose from Day 5 + 50% of IR dose from Day 5 || 30-50 mg po q3h prn
|}

[[Category:Medications]]
[[Category:Opioid substitution therapy]]
[[Category:Addiction medicine]]