From the Guidelines
The maximum dose of MS Contin, a controlled-release oral formulation of morphine sulfate, is 200mg every 8-12 hours, with a total daily dose not exceeding 800mg. However, in opioid-tolerant patients, the dose may be titrated up to 400mg every 8-12 hours, with a maximum total daily dose of 1600mg 1.
Key Considerations
- It is essential to individualize dosing and monitor patients closely for signs of overdose or excessive sedation, particularly when initiating or adjusting therapy with MS Contin.
- The dose should be adjusted based on the patient's response to the medication, with a focus on achieving adequate pain relief while minimizing adverse effects.
- Patients should be evaluated regularly, with dose adjustments made as needed to ensure optimal pain management.
Administration and Monitoring
- MS Contin can be administered every 8-12 hours, with some patients requiring more frequent dosing due to individual variability in response to the medication 1.
- Patients who experience breakthrough pain can be given an immediate-release formulation of morphine, with the dose determined based on their current regimen and response to the medication.
- It is crucial to keep the drug regimen as simple as possible, with increases in dose preferred over increases in frequency of administration to minimize adverse effects and improve patient compliance 1.
From the Research
Maximum Dose of MS Contin (Morphine Sulfate)
- The maximum dose of MS Contin is not explicitly stated in the provided studies, but the studies report a range of doses used in clinical trials.
- According to the study 2, patients had a broad range of morphine requirements, with a mean daily MS Contin dose of 240 mg and a range of 60 mg/day to 1800 mg/day.
- The study 2 also reports that various MS Contin tablet strengths were developed, including 15-mg, 30-mg, 60-mg, and 100-mg tablets, which were found to be bioequivalent and dose proportional.
- Another study 3 reports that the effective dose of MS Contin was 60 mg/day in almost all patients, with a median duration of response of 45 days.
- The study 4 reports a daily morphine dose of 183.9 +/- 140.0 mg (mean +/- SD) in patients who received MS Contin every 12 hours.
- The study 5 reports that 21 of 37 patients were stabilized on MS Contin administered every 12 hours, with a reduction of over 20% in their average daily morphine dose.
- The study 6 compares the pharmacokinetics of MS Contin with a new, extended-release morphine formulation, Avinza, and reports that MS Contin demonstrated similar bioavailability to Avinza, but with a higher peak-to-trough fluctuation in morphine concentration over a 24-hour period.
Dose Titration and Administration
- The studies suggest that MS Contin should be administered on a 12-hour or 8-hour schedule, with dose titration to individual needs.
- The study 2 reports that approximately 93% of patients achieved satisfactory to excellent analgesia on a 12-hour regimen, while the remaining patients were successfully maintained on an 8-hour regimen.
- The study 5 reports that patients were initially titrated to individual needs on a four-hourly schedule with standard oral morphine sulfate tablets, and then switched to an eight-hourly MS Contin regimen.