Morphine ER capsules
KADIAN
Pronunciation: MOR-feen
“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)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRespiratory depression, dependence and overdose; risk rises sharply with sedatives or impaired clearance.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Severe and persistent pain needing extended daily opioid, alternatives inadequate (not PRN) | Opioid-naïve (first opioid) | Do not start with this product — begin with IR morphine, then convert | Individualized | Undefined |
| Severe and persistent pain (as above) | Opioid non-tolerant | 30 mg q24h | Individualized; consider q12h if q24h inadequate | Undefined (single dose >60 mg, TDD >120 mg, or 100 mg capsule: opioid-tolerant only) |
| Severe and persistent pain — conversion from other oral morphine | On other oral morphine | ½ total daily oral morphine dose q12h, or full total daily dose q24h | Individualized (not bioequivalent to other ER morphine — monitor) | Undefined; no data for dosing more often than q12h |
| Severe and persistent pain — conversion from other opioids | On non-morphine opioids or parenteral morphine | 30 mg q24h (no established conversion ratios); parenteral→oral morphine typically 3× daily parenteral dose; other opioids: begin with half estimated daily morphine need | Individualized; underestimate and use IR rescue | Undefined |
Titration Every 1 to 2 days
Renal Renal failure: start lower than usual dosage and titrate slowly with monitoring for respiratory depression, sedation, hypotension
Hepatic Cirrhosis: start lower than usual dosage and titrate slowly with monitoring for respiratory depression, sedation, hypotension
Opioid-tolerant = ≥1 week of ≥60 mg/day oral morphine, 25 mcg/h transdermal fentanyl, 30 mg/day oral oxycodone, 8 mg/day oral hydromorphone, 25 mg/day oral oxymorphone, 60 mg/day oral hydrocodone, or equianalgesic
Instructions
- Swallow capsules whole; do not cut, break, chew, crush, or dissolve pellets
- Or sprinkle pellets on a small amount of applesauce, swallow immediately without chewing, rinse mouth; discard unused portion; no other foods
- May give via French gastrostomy tube: flush tube, pellets in 10 mL water, swirl into funnel, rinse with further 10 mL until no pellets remain; do NOT give via nasogastric tube
- Dose once daily (q24h) or twice daily (q12h); not more often than q12h
- Discontinue other around-the-clock opioids when starting
- Do not stop abruptly in dependent patients; taper by no more than 10% to 25% of total daily dose every 2 to 4 weeks; pause or slow if withdrawal
- Discuss naloxone availability at initiation and renewal
Available strengths
- ER cap 10, 20, 30, 50, 60, 80, 100 mg
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
- Concurrent MAOI use or MAOI use within the last 14 days
- Known or suspected gastrointestinal obstruction, including paralytic ileus
Cautions
- Addiction, abuse, and misuse
- Life-threatening respiratory depression
- Concomitant benzodiazepines or other CNS depressants
- Neonatal opioid withdrawal syndrome
- Opioid analgesic REMS
- Opioid-induced hyperalgesia and allodynia
- Respiratory depression in chronic pulmonary disease or elderly, cachectic, debilitated patients
- Interaction with MAOIs
- Adrenal insufficiency
- Severe hypotension
- Increased intracranial pressure, brain tumors, head injury, impaired consciousness
- Gastrointestinal conditions
- Seizures in seizure disorders
- Withdrawal (avoid mixed agonist/antagonists; no abrupt discontinuation)
- Driving and operating machinery
Adverse reactions
- Constipation
- Nausea
- Somnolence/drowsiness
- Dizziness
- Anxiety
- Vomiting
Pregnancy Prolonged use in pregnancy can cause neonatal opioid withdrawal syndrome; no product data, published human studies show no clear association with major birth defects, animal studies showed harm; not recommended during or immediately before labor.
Lactation Morphine is present in breast milk; breastfeeding not recommended during treatment (risk of infant sedation/respiratory depression).
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)
Active metabolites
Open Morphine ER capsules in the interactive console ↗
Memory aids: interaction avatars
Open Morphine ER capsules in the interactive console ↗
Self-check
- May KADIAN capsules be opened for swallowing difficulty?
Yes—sprinkle intact pellets on applesauce. - Which sedative co-medication increases KADIAN overdose risk?
Benzodiazepines.