Morphine ER capsules
KADIAN
Pronunciation: MOR-feen
“Ms. Cotton(tail) Morphing”
opioids constrict pupils
What it isExtended-release mu-opioid agonist; severe chronic pain requiring continuous opioid therapy.
Why this oneIts capsules may be opened and the pellets sprinkled on applesauce (never crushed), an option when intact extended-release tablets cannot be swallowed.
What limits itRenal accumulation, respiratory depression, and benzodiazepine co-use markedly increase overdose risk.
FDA-approved for
- chronic pain (around-the-clock) (1996)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Moderate to severe pain requiring continuous around-the-clock opioid (not PRN) | Opioid-naive | 10-20 mg QD or BID | Individualized | No maximum defined |
| Moderate to severe pain (conversion from other oral morphine) | Half total daily oral morphine dose q12h, or total daily dose q24h | Individualized | No maximum defined |
Titration No more frequently than every other day (opioid-naive: increase by ~20 mg every other day)
Renal Use with caution; reduced dosage in severe renal insufficiency
Hepatic Use with caution; reduced dosage in severe hepatic insufficiency
Do not dose more frequently than every 12 hours
Instructions
- Swallow capsules whole; do not chew, crush, or dissolve
- May sprinkle pellets on a small amount of room-temperature applesauce; use immediately, do not divide
- May give via 16 French gastrostomy tube; do NOT give via nasogastric tube
- 100 mg and 200 mg capsules for opioid-tolerant patients only
- Taper gradually on discontinuation to prevent withdrawal
Available strengths
- ER cap 10, 20, 30, 50, 60, 80, 100 mg
- tab 15, 30 mg
- ER tab 15, 30, 60, 100, 200 mg
- sol 20, 100 mg/5 mL
- sol 2, 4, 10 mg/mL
- tincture 1 g/100 mL
- tincture 10 mg/mL
- supp 5, 10, 20, 30 mg
- + 1 other marketed form not shown
Contraindications
- Respiratory depression (in the absence of resuscitative equipment or in unmonitored settings)
- Acute or severe bronchial asthma or hypercarbia
- Known or suspected paralytic ileus
- Any situation where opioids are contraindicated
Cautions
- Respiratory depression is the chief hazard; extreme caution in COPD, cor pulmonale, decreased respiratory reserve, hypoxia/hypercapnia
- Additive CNS depression with alcohol, sedatives, other opioids, MAOIs (do not use within 14 days of MAOI)
- Severe hypotension/orthostatic hypotension
- Head injury/increased intracranial pressure
- Spasm of sphincter of Oddi; caution in biliary tract/pancreatic disease
- Misuse, abuse, addiction, diversion potential
- Neonatal withdrawal with prolonged maternal use
- Tolerance and physical dependence
Adverse reactions
- Drowsiness
- Constipation
- Nausea
- Dizziness
- Anxiety
- Vomiting
Pregnancy Pregnancy Category C; use only if benefit justifies fetal risk. Prolonged use can cause neonatal opioid withdrawal syndrome.
Lactation Low levels of morphine detected in human milk; withdrawal can occur in breastfed infant when maternal drug stopped; weigh benefits vs discontinuing.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 10 mg | ER cap | 30 qd | $78.17 | not offered |
| 20 mg | ER cap | 30 qd | $92.43 | not offered |
| 30 mg | ER cap | 30 qd | $98.47 | not offered |
| 50 mg | ER cap | 30 qd | not offered | |
| 60 mg | ER cap | 30 qd | $149.27 | not offered |
| 80 mg | ER cap | 30 qd | not offered | |
| 100 mg | ER cap | 30 qd | not offered |
Other forms: Morphine (morphine sulfate IR) · Morphine ER tablets (MS CONTIN)
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
- Risk from concomitant use with benzodiazepines
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.
Active metabolites
Open Morphine ER capsules in the interactive console ↗
Memory aids: interaction avatars
