Surrey Heartlands

Joint Formulary & PAD

Morphine sulfate - Pain

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Status 1

Green (see narrative)
Formulations :
  • Immediate release tablets
  • Oral solution
  • Oro-dispersible
Formulary Status :
Primary Care
ASPH
RSFT
SASH
SABP
Associated Icons :
Guidelines BNF SPC
CD
Restrictions / Comments :
Important
Orodispersible tablets are a cost-effective alternative to oral solution. Reserve oral solution and orodispersible tablets for patients in whom a solid dose form is not suitable.
 

Status 2

Green (see narrative)
Formulations :
  • Capsules (slow release)
  • Granules (slow release)
  • Tablets (slow release)
Formulary Status :
Primary Care
ASPH
RSFT
SASH
SABP
Associated Icons :
Guidelines BNF SPC
CD
Restrictions / Comments :
Important
Prescribe modified-release preparations by brand - refer to local guidelines for preferred brands. Zomorph capsules (12-hourly) can be opened for administration in patients unable to swallow the capsules.
 

Status 3

Red
Formulations :
  • Injection
  • Solution for infusion
Formulary Status :
Primary Care
ASPH
RSFT
SASH
SABP
Associated Icons :
Guidelines BNF SPC
CD
Restrictions / Comments :
Important
See separate listing for palliative care
 

Status 4

Non Formulary
Formulations :
  • Suppositories
Formulary Status :
Primary Care
ASPH
RSFT
SASH
SABP
Associated Icons :
Guidelines BNF SPC
CD
NFD1
Restrictions / Comments :

Documentation

Webpage
Brand-name Prescribing in Primary Care
Patient resource
Pain management - Prescription agreement (Patient) - May 24
Patient resource
Pain management - Prescription agreement (Patient) - June 2018.docx
Patient resource
Pain (Persistent) - Opioids -Patient Information - April 2018.docx
Information
Pain -Opioids - Assessment Tool- April 2018.docx

PAD Profile

ChemicalSubstance :
Morphine sulfate
Indication :
Pain
Group Name :
Keywords :
Strong opioids, analgesia, opioid analgesics
Brand Names Include :
MST, Morphgesic, Sevredol, Zomorph, MXL, Oramorph, Actimorph
Important Information :
Latest Additions Date From :
Latest Additions Date To :
Guidelines :
Pain
Supporting Documents :
5
Traffic Light Entries :
4

Other Indications

Below are listed other indications that Morphine sulfate is used to treat.

Other Drugs

Below are listed other drugs that are used to treat Pain .

Committee Recommendations (2)

07 Aug 19 - Surrey & North West Sussex Area Prescribing Committee (formerly Prescribing Clinical Network)

Zomorph® is the locally preferred brand of morphine sulfate modified release (12-hourly formulation). 

Branded prescribing is recommended for morphine sulfate MR preparations by UKMi (see branded prescribing guidance below). Prescribers should identify patients currently prescribed generic preparations and change to the preferred branded product – Zomorph®.

Key points for consideration:
- Prescribers should be aware that there is no 5mg Zomorph® available so may wish to initiate MST® as the preferred brand if 5mg presentation is required.
- Switching MST® to Zomorph® is an option as they are bioequivalent.
- MXL is the only brand available for 24 hour preparations
- Zomorph® capsules can be opened and administered orally or via a tube – granules / capsules should not to be crushed

06 Jun 18 - Surrey & North West Sussex Area Prescribing Committee (formerly Prescribing Clinical Network)

A stepped approach to pain management is recommended. Morphine is the 1st line  treatment option where a strong opioid is indicated. Please refer to the guidelines attached.

It is recommended  that morphine oral modified release (MR) preparations are prescribed by BRAND - see UKMI Branded Prescribing Recommendations document below. Patients currently receiving generically written prescriptions for morphine MR preparations should be reviewed with a view to changing the prescribing to a more cost-effective brand.
Please note that Zomorph® capsules can be opened up for patients who are unable to swallow.

Ensure a patient agreement is completed by the patient (see below) prior to a trial of Morphine