MS CONTIN Dosage & Rx Info | Uses, Side Effects

Ms Contin Generic Name & Formulations

Legal Class

CII

General Description

Morphine sulfate 15mg, 30mg, 60mg, 100mg, 200mg; ext-rel tabs.

Pharmacological Class

Opioid agonist.

How Supplied

XR tabs—100

Manufacturer

Rhodes Pharmaceuticals

Generic Availability

YES

Mechanism of Action

Morphine sulfate is a full opioid agonist and is relatively selective for the mu receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of morphine is analgesia. Although the precise mechanism of the analgesic action is unknown, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug.

Ms Contin Indications

Indications

Management of severe and persistent pain that requires an extended treatment period with a daily opioid analgesic and for which alternative therapies are inadequate.

Limitations of Use

Due to risks of addiction, abuse, and misuse with opioids (can occur at any dosage or duration); increased risks of overdose and death with extended-release/long-acting opioid formulations, reserve for use in patients for whom alternative treatment options (eg, non-opioid analgesics, immediate-release opioids) are ineffective, not tolerated, or inadequate to provide sufficient management of pain. Not indicated as an as-needed (prn) analgesic.

Ms Contin Dosage and Administration

Adult

Use lowest effective dose for shortest duration. Swallow whole. Individualize. Opioid-naive: initially 15mg every 8hrs or 12hrs. Opioid non-tolerant: initially 15mg every 12hrs. May adjust dose every 1–2 days. Use 100mg, 200mg tabs, a single dose >60mg, or a total daily dose >120mg in opioid-tolerant patients only. Renal failure, cirrhosis: initiate at lower dose; titrate slowly and monitor. Concomitant CNS depressants: initially 15mg every 12hrs; monitor and consider using a lower CNS depressant dose. Conversion from other morphine formulations or other opioids: see full labeling. Withdraw gradually (esp. if opioid-dependent), taper by ≤10–25% every 2–4 weeks.

Children

<18yrs: not established.

Administration

Swallow whole. Do not crush, chew or dissolve.

Nursing Considerations

Swallow whole. Do not crush, chew or dissolve.

Ms Contin Contraindications

Contraindications

Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. During or within 14 days of MAOIs. Known or suspected GI obstruction, including paralytic ileus.

Ms Contin Boxed Warnings

Boxed Warning

Serious and life-threatening risks from use of MS Contin: Addiction, abuse, and misuse; Life-threatening respiratory depression; Accidental ingestion; Risks from concomitant use with benzodiazepines or other CNS depressants; Neonatal opioid withdrawal syndrome; Opioid analgesic risk evaluation and mitigation strategy (REMS).

Ms Contin Warnings/Precautions

Warnings/Precautions

Assess the potential need for access to naloxone when initiating and renewing therapy. Consider prescribing naloxone based on risk factors for overdose (eg, history of opioid use disorder, prior opioid overdose, household members or other close contacts at risk for accidental ingestion or overdose). Abuse potential (monitor). Life-threatening respiratory depression esp. during initiation or following dose increases. Accidental exposure may cause fatal overdose (esp. in children). Sleep-related breathing disorders (including central sleep apnea (CSA), sleep-related hypoxemia); consider dose reduction if CSA develops. Opioid-induced hyperalgesia (OIH) and allodynia; consider decreasing dose of current opioid or opioid rotation if OIH is suspected. COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Monitor for signs of hypotension when initiating or titrating dose. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Renal or hepatic impairment. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery, nursing mothers: not recommended.

REMS

YES

Ms Contin Pharmacokinetics

Absorption

Oral bioavailability: ~20–40%.

Distribution

Volume of distribution: 3–4 L/kg. Plasma protein bound: 30–35%.

Metabolism

Hepatic (glucuronidation).

Elimination

Renal. Half-life: 2–4 hours (after IV admin).

Ms Contin Interactions

Interactions

See Contraindications. Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor closely; consider prescribing naloxone if concomitant use is warranted. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT₃ antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. May be potentiated by cimetidine, P-gp inhibitors (eg quinidine); monitor. May increase serum amylase.

Ms Contin Adverse Reactions

Adverse Reactions

Constipation, dizziness, sedation, nausea, vomiting, sweating, dysphoria, euphoria; respiratory depression, orthostatic hypotension, syncope, OIH and allodynia.

Ms Contin Clinical Trials

See Literature

Ms Contin Note

Not Applicable

Ms Contin Patient Counseling