Generic drug of the therapeutic class: Analgesics
active ingredients: Morphine sulphate
laboratory: Bristol Myers Squibb
Box of 14
Intense or resistant pain with lower level analgesics, especially pain of cancerous origin.
Dosage ACTISKENAN 20 mg Capsule Box of 14
Reserved for adults and children over 6 months.
The oral immediate release form of morphine is mainly adapted to particular clinical situations: emergencies, rapid equilibration of very intense pain, unstable pain, metabolic disorders (renal failure), elderly people.
ADMINISTRATION MODE :
- With immediate-release forms, the total daily dose is usually divided into six doses, most often equivalent, 4 hours apart.
This form can also be used as an additional dose in case of pain access not controlled by a background treatment (for example, morphine sustained release).
- In children under 6 years the capsule MUST be opened; there is a risk of misdirection in case of administration of the whole capsule. In patients who can not swallow the entire capsule, it can be administered directly into a semi-solid diet (puree, jam, yoghurt), or in gastric or gastrostomy tubes with a diameter greater than 16 FG and / or diameter internal superior or equal to 2.5 mm with distal end open or with lateral pores. Rinsing the probe with 10 to 50 ml of water is sufficient.
- In adults: As a general rule, the starting daily dose is 10 mg every 4 hours, or 60 mg per day.
- In fragile patients:
All doses are halved and / or spaced 6 to 8 hours (very old patient, renal or hepatic insufficiency, hypoprotidemia ...).
- In the elderly subject:
Treatment should be started with a dose of 2.5 to 5 mg of oral morphine LI 4 to 6 times daily, ie 10 to 30 mg per day. - In children:
The starting daily dose is 1 mg / kg and per day.
- In patients with renal insufficiency:
Doses will also be reduced compared to a subject with normal renal function and adjusted according to the needs of the patient. - If the morphine treatment needs to be continued for several weeks, the prescription of morphine LI can be relayed by morphine LP at equivalent daily dose. DOSAGE ADAPTATION:
- Frequency of the evaluation:
Do not dwell on a dosage that is ineffective. The patient must therefore be seen closely, mainly at the start of treatment, as long as the pain is not controlled. - Dosage adjustment:
. If the pain is not controlled, the unit dose of morphine LI can be increased by 25 to 50% depending on the age and physiological state of the patient.
. In case of insufficiency of relief, the patient can resort to an interdose every hours without exceeding 4 successive catches in four hours.
. If the patient regularly uses more than 3 or 4 interdos distributed throughout the day, these additional doses must be incorporated into the total daily dosage of morphine LI without waiting more than 48 hours.
. In these dose adjustment processes, there is no upper limit as long as the adverse effects can be controlled. - Correspondence between the different routes of administration:
The dosage varies according to the route of administration.
When compared to the oral route, the intravenous dose should be divided by three and the subcutaneous dose should be divided by two.
Switching from one route of administration to another must take these factors into account in order to maintain the same amount of bioavailable morphine.
In the case of relaying from an oral immediate release form to an oral sustained release form, the daily dosage will be unchanged.
- This medicine should never be used in the following cases:
. known hypersensitivity to morphine or any other component of the product,
. child under 6 months,
. decompensated respiratory failure (in the absence of artificial ventilation),
. severe hepatocellular insufficiency (with encephalopathy),
. acute: head trauma and intracranial hypertension in the absence of controlled ventilation,
. uncontrolled epilepsy,
. breastfeeding, in case of initiation or continuation after the birth of a long-term treatment,
. combinations with buprenorphine, nalbuphine and pentazocine (see section on interactions).
- Due to the presence of sucrose, this medicinal product should not be used in cases of fructose intolerance, glucose-galactose malabsorption syndrome or sucrase-isomaltase deficiency.
NOT RECOMMENDED :
Associations advised against : naltrexone; alcoholic beverages and drugs containing alcohol.
Actiskenan side effects
- Among the most common side effects during initiation of treatment, drowsiness, confusion, nausea and vomiting are reported. They may be transient, but their persistence must search for an associated cause or overdose. Constipation, on the other hand, does not give way to further treatment. All of these effects are predictable and need to be addressed.
- We can also note:
. sedation, excitement, nightmares, especially in the elderly, with possible hallucinations;
. respiratory depression with maximum apnea;
. increased intracranial pressure, which should be treated first;
. dysuria and urinary retention in case of prostatic adenoma or urethral stenosis;
. pruritus and redness;
. Withdrawal syndrome with abrupt discontinuation of this drug: yawning, anxiety, irritability, insomnia, chills, mydriasis, hot flushes, sweating, watery eyes, rhinorrhea, nausea, vomiting, anorexia, abdominal cramps, diarrhea, myalgia, arthralgia.
- In elderly patients or patients with renal insufficiency, exceptional risk of developing myoclonus in case of overdose or too rapid increase in doses.