Morphine ER tablets
MS CONTIN
Pronunciation: MOR-feen (em-es-KON-tin)
“Ms. Cotton(tail) Morphing”
opioids constrict pupils
What it isMorphine sulfate extended-release tablets q8–12h (MS CONTIN, 1987) are full mu-opioid agonists for continuous, around-the-clock severe pain.
Why this oneIt is the benchmark extended-release morphine tablet, sustaining analgesia without frequent immediate-release dosing.
What limits itSwallow intact; crushing can release a fatal amount. Active metabolites accumulate in renal impairment.
FDA-approved for
- chronic pain (around-the-clock) (1987)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe and persistent pain requiring an opioid, inadequately treated by alternatives | Adults, not opioid-tolerant | 15 mg q8–12h | individualized | No ceiling; >60 mg single dose or >120 mg/day only if opioid-tolerant |
Titration Dosage adjustments may be done every 1 to 2 days (steady state approximated in ~1 day)
Renal Altered pharmacokinetics — start with lower than usual dose and titrate slowly
Hepatic Altered pharmacokinetics in cirrhosis — start with lower than usual dose and titrate slowly
A single dose >60 mg, or total daily dose >120 mg, only for opioid-tolerant patients
Instructions
- Administer orally every 8 or 12 hours
- Swallow tablets whole; do not cut, break, chew, crush, or dissolve (risk of fatal dose)
- Do not abruptly discontinue in physically dependent patients; taper by ~10–25% of total daily dose every 2–4 weeks
- If on a CNS depressant, start at 15 mg q12h and consider lower depressant dose
Available strengths
- ER tab 15, 30, 60, 100, 200 mg
- tab 15, 30 mg
- ER cap 10, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120 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
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
- Concurrent use of monoamine oxidase inhibitors (MAOIs) or use of MAOIs within the last 14 days
- Known or suspected gastrointestinal obstruction, including paralytic ileus
Cautions
- Opioid-induced hyperalgesia and allodynia
- Life-threatening respiratory depression in chronic pulmonary disease or elderly/cachectic/debilitated patients
- Adrenal insufficiency
- Severe hypotension; avoid in circulatory shock
- Increased intracranial pressure / head injury / impaired consciousness
- Risk of seizures in seizure disorders
- Serotonin syndrome with serotonergic drugs
- Withdrawal on abrupt discontinuation
Adverse reactions
- Constipation
- Nausea
- Sedation
- Dizziness
- Vomiting
- Sweating
- Dysphoria
- Euphoric mood
Pregnancy Prolonged use can cause neonatal opioid withdrawal syndrome; no clear association with major birth defects; animal data show neural tube and other defects; not recommended during/immediately before labor
Lactation Morphine present in breast milk; breastfeeding not recommended due to risk of sedation and respiratory depression in infant
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 15 mg | ER tab | per unit | $0.31/ea | not offered |
| 30 mg | ER tab | per unit | $0.44/ea | not offered |
| 60 mg | ER tab | per unit | $0.66/ea | not offered |
| 100 mg | ER tab | per unit | $0.85/ea | not offered |
| 200 mg | ER tab | per unit | $2.13/ea | not offered |
Other forms: Morphine (morphine sulfate IR) · Morphine ER capsules (KADIAN)
⚠ 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 tablets in the interactive console ↗
Memory aids: interaction avatars
