Can you cut ms contin in half

The isolation of morphine. Mol Interv. Accessed in February, Blakemore P, White J. Morphine, the proteus of organic molecules. Chem Commun Camb ; 11 — Opiate receptor: Its demonstration in nervous tissue. Identification of two related pentapeptides from the brain with potent opiate agonist activity. McCleane G, Smith H. Opioids for persistent noncancer pain. Med Clin N Am. Chahl LA. Opioids — mechanism of action. Aust Prescr.

Nestler EJ. Molecular basis of long-term plasticity underlying addiction. Nat Rev Neurosci. Stoelting RK. Pharmacology, Physiology and Anesthetic Practice.

Hasslesstrom J, Sawe J. Morphine pharmacokinetics and metabolism in humans. Enterohepatic cycling and relative contribution of metabolites to active opioid concentrations. Clin Pharmacokinet. Lotsch J, Geisslinger G. Morphineglucuronide: An analgesic of the future? Morphine in cancer pain management. Support Care Cancer. Opioid guidelines in the management of chronic non-cancer pain. McCarberg B, Barkin R.

Long-acting opioids for chronic pain; pharmacotherapeutic opportunities to enhance compliance, quality of life, and analgesia. Am J Ther. Comparison of controlled-release and immediate-release oxycodone tablets AVINZA and chronic noncancer pain — inpatients with cancer pain. J Clin Oncol. Treatment of osteoarthritis pain with controlled release oxycodone or fixed combination oxycodone plus acetaminophen added to nonsteroidal anti-inflammatory drugs: A double blind, randomized, multicenter, placebo controlled trial.

J Rheumatol. Immediate or sustained-release morphine for dose finding during start of morphine to cancer patients: A randomized, double-blind trial. American Pain Society. Pain Pract. Rauck RL. What is the case for prescribing long-acting opioids over short-acting opioids for patients with chronic pain?

A critical review. Package insert. Stamford, CT: Purdue Fredrick; Leslie S. The Contin delivery system: Dosing considerations. J Allergy Clin Immunol.

Comparison of the bioavailability of aminophylline in a conventional base and in a continuous-release base. J Clin Pharmacol. Gourlay GK. Sustained relief of chronic pain pharmacokinetics of sustained release morphine. Newport, KY: Xanodyne Pharmaceuticals; Piscataway, NJ: Alpharma Pharmaceuticals; Bristol, TN: King Pharmaceuticals; Semenchuk MR.

Curr Opin Invest Drugs. Control of severe pain with sustained-release morphine tablets v. Effects of controlled-released morphine on quality of life for cancer pain. Oncol Nurs Forum. A patient preference study comparing two extended-release morphine sulfate formulations for cancer pain. Clin Drug Invest. Vallerand AH. The use of long-acting opioids in chronic pain management.

It is vitally important that people who have a prescription for MS Contin not share their medication and dispose of any remaining tablets properly after their course of treatment is complete. A single tablet of MS Contin is strong enough to cause lethal overdose in someone who does not have a tolerance to opiates, especially children. The U. If you are taking a single course of morphine and still experiencing pain after it is complete, call your doctor.

If you will be taking MS Contin long-term, make sure to speak with your doctor regularly to ensure you get new prescriptions in a timely fashion. Taking these steps is normal and not considered a sign of addiction or drug-seeking behavior.

If you have a prescription for MS Contin and suspect that someone you know may be abusing the drug, keep a close eye on your medication and check to see if any tablets are missing. If you, or a loved one, are addicted to MS Contin, there is help. If you are dependent on the drug, you may be able to work with your doctor to gradually reduce your dose, tapering off morphine slowly. For addiction, it is often necessary to enter into a detoxification facility.

Detox can provide stabilizing medications to reduce or prevent withdrawal while your body recovers and returns to normal. Either way, your chances of relapsing back into morphine addiction are greatly reduced if you receive treatment afterward, reports the National Institute on Drug Abuse NIDA. Do not use extended-release tablets that are broken. If you cannot swallow the extended-release capsule, you may open it and pour the contents into a small amount of applesauce.

Stir this mixture well and swallow it right away without chewing. Do not receive this medicine through a nasogastric tube. While taking the extended-release tablet, part of the tablet may pass into your stool. This is normal and nothing to worry about. Morphine extended-release capsules or tablets work differently from the regular morphine oral solution or tablets, even at the same dose.

Do not switch from one brand or form to the other unless your doctor tells you to. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Further, prolonged maternal use of long-acting opioids, such as morphine, during pregnancy may result in neonatal opioid withdrawal syndrome NOWS. Severe symptoms may require pharmacologic therapy managed by clinicians familiar with neonatal opioid withdrawal. Monitor the neonate for withdrawal symptoms including rapid breathing, irritability, hyperactivity, abnormal sleep pattern, high-pitched crying, tremor, vomiting, diarrhea, and failure to gain weight.

Onset, duration, and severity of opioid withdrawal may vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination by the newborn.

Opiate agonist; alkaloid obtained from the unripened seed capsules of the opium poppy Used for the relief of moderate to severe acute and chronic pain, preoperative sedation and as a supplement to anesthesia Available in multiple formulations. Do not use Kadian capsules as a first opioid analgesic; initiate with an immediate-release formulation and then convert patients to Kadian.

With the exception of Avinza, adjust the dose every 1 to 2 days based upon the total daily morphine requirements extended-release dose plus breakthrough doses. Adjust the dose of Avinza every 3 to 4 days in increments of 30 mg or less.

Monitor patients frequently for respiratory depression, particularly during the first 24 to 72 hours after initiation or dose escalation. Discontinue all other around-the-clock opioids. To convert from other morphine formulations, calculate the morphine hour oral requirement; in general, the hour oral requirement is 3 times the hour parenteral requirement. When initiating extended-release morphine, anticipate and treat breakthrough pain with adequate doses of immediate-release morphine as needed.

When converting from other opioids, established conversion ratios to extended-release formulations have not been defined by clinical trials. Alternatively, initiate with one-half of the calculated morphine hour oral requirement estimate, anticipating breakthrough pain and providing adequate doses of immediate-release morphine as needed.

When converting from methadone, potency ratios to convert to other opioids can vary widely, warranting extreme caution during conversion to extended-release morphine to avoid overdosage.

With the exception of Avinza, adjust dosage every 1 to 2 days based on total daily morphine requirements extended-release dose plus breakthrough doses. Adjust Avinza dose every 3 to 4 days. Monitor frequently for respiratory depression, especially 24 to 72 hours after initiation or dose escalation.

Although FDA-approved product labeling provides adult dosing for both opioid-naive and opioid-tolerant patients, it would be prudent to limit pediatric use to opioid-tolerant patients. Limited data are available, and there is wide variability in dosage needs.

Doses of 0. Begin at the lower end of the dosage range, and titrate to pain relief. Do not exceed recommended adult doses; the initial adult dosage recommendation is 15 mg PO every 8 to 12 hours, with the longer interval used in opioid-naive patients. Many experts recommend beginning with an immediate-release product to titrate to an appropriate daily dose and then switch to an extended-release formulation and divide the patient's total daily dose into 2 or 3 equal doses.

Extended-release morphine should not be used for as needed analgesia and is only appropriate for a select group of children; only clinicians highly experienced in pediatric pain management should prescribe extended-release formulations.

Initially, 15 to 30 mg PO every 4 hours as needed. Titrate to pain relief. When converting parenteral to oral morphine, an oral dose that is 3 times the parenteral dose is generally sufficient. When converting from extended-release morphine, give the same hour total as a divided regimen given at appropriate intervals.

When converting from other oral or parenteral opioids, calculate the hour total dose of the current opioid and consult published relative potency information for conversion. Monitor for sedation and respiratory depression, particularly when therapy is initiated or dosage changes occur. To discontinue, gradually taper the dose to prevent signs and symptoms of withdrawal.

General weight-based dosing for pediatric patients is 0. Initially, 10 to 20 mg PO every 4 hours as needed. Higher doses 10 mg are recommended for IM or subcutaneous administration; dosage may range from 5 to 20 mg IM or subcutaneously every 4 hours depending on patient requirements and response. NOTE: Continuous infusions should only be used in acute care settings e.

Loading doses of 15 to 20 mg may be required for adequate analgesia; higher doses may be needed in opioid-tolerant patients. Higher infusion rates may be required in opioid-tolerant patients. Titrate dose to pain relief. A bolus of 0. Initial infusion rates of 0. Alternatively, rates of 0. Higher maintenance infusion rates up to 0. May increase up to 0. An initial infusion rate of 0. The mean infusion rate was 0.

Higher infusion rates, ranging from 0. The starting dose should be based on the patient's recent exposure to opioids. Titrate the regimen to patient response. Larger doses may be needed in opioid-tolerant patients. Various regimens have been reported.

The following settings have been used in pediatric patients; titrate regimen to patient response. Demand dose: 0. Initially, inject 5 mg epidurally in the lumbar region and assess the patient in 1 hour; if pain relief is not adequate at that time, administer incremental doses of 1 to 2 mg, with sufficient time between injections to appropriately assess for efficacy.

The manufacturer recommends a maximum of 10 mg per 24 hours. For continuous epidural infusion, initiate at 2 to 4 mg per 24 hours, with additional doses of 1 to 2 mg given if pain relief is not initially achieved.

The incidence of early and late respiratory depression is dramatically increased with thoracic administration. Use preservative-free formulations only. Various regimens have been reported including single preoperative and postoperative doses of 0.

Intrathecal dosage is usually one-tenth the epidural dosage. Single preoperative doses of 0. Use preservative free formulations only. Use caution in geriatric patients due to the potential for adverse CNS effects; and consider alternative drugs for treatment. Use caution in geriatric patients due to the potential for adverse CNS effects; consider alternative drugs for treatment.

Although no published studies exist on the effectiveness of nonspecific antimotility agents in treating AIDS-associated diarrhea, opioid agonists may be effective. Doses are given in addition to other opiate pain medications. Initially, 2 to 5 mg IV every 5 to 30 minutes as needed for pain; some patients may require maintenance doses of 4 to 8 mg IV every 4 to 6 hours. Premedication with a benzodiazepine may potentiate the response to morphine; a reduced morphine dose may be needed.

Use the lower end of the range for opioid-naive neonates. Onset is typically 5 minutes. Use a preservative-free formulation. Use an initial dosage of 15 mg PO twice daily in those who are not opioid tolerant, and consider this lower dose in geriatric patients or those weighing less than 60 kg. For Kadian, Avinza, and equivalent generic dose forms that may be given once daily, the highest starting dose for patients who are not opioid tolerant is 30 mg PO every 24 hours [Kadian is administered at a frequency of either once daily every 24 hours or twice daily every 12 hours ; Avinza is administered at a frequency of once daily every 24 hours ].

Clinical practice guidelines classify morphine as probably effective for the treatment of painful diabetic neuropathy. Initially, 0. Once the patient is on a stable dose, individualize weaning based on the patient's symptoms. Titrate based on efficacy and adverse effects.

Longer-acting and controlled-release drugs are preferred, especially at night. Camphorated opium tincture 0. Extended-release capsules, extended-release tablets Arymo ER or Morphabond , DepoDur liposome injection: Safety and efficacy have not been established. Immediate-release formulations, injectable solution NOT DepoDur : With appropriate dosage titration, there is no maximum dose. Extended-release formulations, DepoDur liposome injection: Safety and efficacy have not been established.

With the exception of morphine sulfate extended-release liposome injection, which is only used as a single epidural dose, morphine dosage should be modified depending on clinical response and degree of hepatic impairment. Begin treatment with a lower than usual initial dosage, and titrate slowly while monitoring for sedation, respiratory depression, and hypotension.

The 6-glucuronide and 3-glucuronide metabolites are renally eliminated. With the exception of morphine sulfate extended-release liposome injection, which is only used as a single epidural dose, morphine dosage should be modified to prevent accumulation of the metabolite and excessive side effects.

NOTE: If Duramorph or Infumorph gets on the skin, remove any contaminated clothing and rinse the affected area with water. When initiating therapy, begin with an immediate-release preparation and titrate to the appropriate analgesic dose and then convert the patient to an extended-release product if appropriate.

Storage: Store morphine securely in a location not accessible by others. Disposal: Flush unused morphine down the toilet when it is no longer needed if a drug take-back option is not readily available. Immediate-release Tablets Administer without regard to meals; may be given with food or milk to minimize gastrointestinal irritation.

Capsule contents may be added to juice and administered immediately or delivered via gastric or nasogastric tube by either adding to or following with liquid. Extended-release Tablets e. Swallow Arymo tablets 1 at a time immediately after placing in the mouth.

Do not pre-soak, lick, or otherwise wet Arymo tablets prior to placing in the mouth; the tablet may become sticky leading to difficulty in swallowing, choking, gagging, or regurgitation. Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of therapy initiation or dose escalation.

MS Contin and mg tablets or Morphabond mg tablets are only for use in patients in whom tolerance to an opioid of comparable potency has been established. Limit use of a single dose of extended-release tablets more than 60 mg or a total daily dose more than mg to opioid-tolerant patients. Capsules may be opened and the contents sprinkled on applesauce at room temperature or cooler immediately prior to ingestion; no other food has been tested.

The applesauce needs to be swallowed without chewing. Do not separate applesauce into separate doses; the entire portion should be taken.