Important Dosing Instructions for MORPHABOND ER

Important Dosing Instructions for MORPHABOND ER

A 1-to-1 conversion of the total daily dose for MS Contin®1

MORPHABOND ER is available in 4 dose strengths, including 100 mg

 

Tablets not shown at actual size.

Taken orally
every 12 hours

Instruct patients to
swallow tablets whole

Can be administered
without regard to food

Dosing Considerations for MORPHABOND ER1

Dosing Considerations for MORPHABOND ER1

  • Start patients who are opioid naïve or who are not opioid tolerant on 15-mg tablets orally every 12 hours
    • Use of higher doses in patients who are not opioid tolerant may cause fatal respiratory depression
  • Discontinue all other around-the-clock opioids when MORPHABOND ER therapy begins
  • A 1-to-1 conversion of the total daily dose of MS Contin®: Patients receiving other oral morphine formulations may be converted to MORPHABOND ER by administering one-half of the patient’s 24-hour requirement every 12 hours
  • There are no established conversion ratios for conversion from other opioids to MORPHABOND ER defined by clinical trials
    • Initiate dosing using MORPHABOND ER 15 mg orally every 12 hours
    • It is safer to underestimate a patient’s 24-hour oral morphine dosage and provide rescue medication (eg, immediate-release morphine) than to overestimate and manage an adverse reaction due to an overdose
  • Individually titrate MORPHABOND ER to a dose that provides adequate analgesia and minimizes adverse reactions
  • Continually reevaluate patients to assess maintenance of pain control and the relative incidence of adverse reaction as well as monitoring for the development of addiction, abuse, or misuse
  • Patients who experience breakthrough pain may require a dosage adjustment of MORPHABOND ER, or may need rescue medication with an appropriate dose of an immediate-release analgesic
    • If the level of pain increases after dose stabilization, attempt to identify the source of the pain before increasing the MORPHABOND ER dose
    • MORPHABOND ER dose adjustments may be done every 1 to 2 days
  • If unacceptable opioid-related adverse reactions are observed, consider reducing the dose
  • Adjust the dose to obtain an appropriate balance between management of pain and opioid-related adverse reactions
  • When the patient no longer requires therapy with MORPHABOND ER, taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal. If a patient develops these signs and symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both
  • Reserve MORPHABOND ER for use in patients for whom alternative treatment options (eg, non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. MORPHABOND ER is not indicated as an as-needed (prn) analgesic
  • Crushing, chewing, or dissolving MORPHABOND ER tablets will result in uncontrolled delivery of morphine and can lead to overdose or death
  • MORPHABOND ER should be prescribed only by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain
  • Use the lowest effective dose for the shortest duration consistent with individual treatment goals
  • Initiate the dosing regimen for each patient individually taking into account the patient’s severity of pain, response, prior analgesic treatment, and risk factors for addiction, abuse, and misuse
  • MORPHABOND ER 100-mg tablets, a single dose greater than 60 mg, or a total daily dose greater than 120 mg are only for use in patients in whom tolerance to an opioid of comparable potency has been established
  • Patients who are opioid tolerant are those receiving, for one week or longer, at least 60-mg oral morphine per day, 25-mcg transdermal fentanyl per hour, 30-mg oral oxycodone per day, 8-mg oral hydromorphone per day, 25-mg oral oxymorphone per day, 60-mg oral hydrocodone per day, or an equianalgesic dose of another opioid
  • Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy or adjusting the dose
  • The effect of food upon the systemic bioavailability of MORPHABOND ER has not been systematically evaluated for all strengths. Administration of a single dose of MORPHABOND ER with a standardized high-fat meal resulted in a 33% increase in morphine peak plasma concentration and no change in area under the curve (AUC) compared to fasted state

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