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 associated risks; reserve ER forms for patients with inadequate tx alternatives; not indicated for prn analgesic use; proper dosing and titration essential to decr. respiratory depression risk
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with 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 patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately; instruct patients 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, especially by children, can result in fatal morphine overdose
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel patients and/or caregivers with 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 opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, moderate-severe chronic
- [opioid-nontolerant patients]
- 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 patients 65 yo and older; do not cut/crush/chew/dissolve tab; >60 mg/dose, >120 mg/day for use in opioid-tolerant patients only; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [opioid-tolerant patients]
- 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 patients 65 yo and older; do not cut/crush/chew/dissolve tab; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
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 opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
pain, moderate-severe chronic (off-label)
- [>12 mo]
- Dose: 0.2-0.8 mg/kg/dose PO q12h; Start: individualize dose based on current opioid intake; Info: use lowest effective dose, shortest effective tx duration; do not cut/crush/chew/dissolve tab; >60 mg/dose, >120 mg/day for use in opioid-tolerant patients only; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
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