From the Research
The maximum daily dose of Kadian (morphine sulfate) is 1600 mg per day, though most patients require much lower doses. Kadian should be initiated at a low dose, especially in opioid-naive patients, and titrated gradually based on pain control and side effects. Dosing is typically done once or twice daily due to its extended-release formulation. When converting from other opioids to Kadian, appropriate equianalgesic dose calculations should be used, with a 25-50% dose reduction initially to account for incomplete cross-tolerance. Kadian is a potent opioid with significant risks including respiratory depression, addiction, and overdose. It should only be used when alternative treatments are inadequate, and patients should be monitored closely, especially during dose adjustments. Tolerance develops with continued use, but increasing doses should be approached cautiously and only when clinically necessary. Due to its high potency and extended-release properties, exceeding recommended doses can lead to serious or fatal respiratory depression, as noted in studies such as 1.
Some key points to consider when prescribing Kadian include:
- Initiating at a low dose and titrating gradually to minimize side effects and risks
- Using appropriate equianalgesic dose calculations when converting from other opioids
- Monitoring patients closely, especially during dose adjustments, due to the risk of respiratory depression, addiction, and overdose
- Being aware of the potential for tolerance development and approaching dose increases with caution
- Considering the flexibility in dosing options, including once or twice daily administration, as discussed in studies like 2 and 3.
It's also important to note that the majority of patients can be effectively managed on lower doses, and the maximum daily dose should only be considered in cases where lower doses are insufficient for pain control, as seen in studies such as 4.