From the Research
The maximum daily dose of Kadian (extended-release morphine sulfate) is typically 1600 mg per day, though this is an extremely high dose that would only be appropriate for opioid-tolerant patients with severe chronic pain. Most patients require much lower doses, often starting at 30-60 mg once daily and gradually titrating upward based on pain control and side effects. Kadian should be taken at the same time each day, swallowed whole without crushing, chewing, or dissolving the capsules, as this would destroy the extended-release mechanism and could lead to a potentially fatal overdose. Dose adjustments should be made no more frequently than every 1-2 days for immediate-release formulations and every 3-4 days for extended-release formulations. Patients with renal or hepatic impairment typically require lower doses. The maximum dose is limited by side effects including respiratory depression, sedation, constipation, and the risk of overdose. Any dose increases should be carefully monitored by a healthcare provider experienced in pain management, especially given the risks associated with high-dose opioid therapy.
Some key points to consider when prescribing Kadian include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for signs of opioid toxicity, such as respiratory depression, sedation, and constipation
- Being aware of the potential for opioid misuse and abuse, and taking steps to mitigate this risk, as discussed in a recent systematic review 1
- Considering alternative pain management options, such as non-pharmacological therapies or other medications, as needed
- Being mindful of the importance of treatment timing, as demonstrated in a study on the analgesic effects of locally administered morphine sulfate 2
It's also important to note that the efficacy and safety of Kadian have been demonstrated in several studies, including a randomized, open-label, multicenter trial comparing once-a-day extended-release morphine sulfate capsules to twice-a-day controlled-release oxycodone hydrochloride tablets for the treatment of chronic, moderate to severe low back pain 3. However, the most recent and highest quality study on this topic is not available in the provided evidence, so the recommendation is based on general knowledge and the available evidence.