This Communication is intended as a guide only and does not equate to expert opinion. Interpretation of recommendations should always
be taken in context with the patient’s current condition and formal clinical assessment. As the information in this publication is subject to
review, please contact a medical or health professional before using this publication. Whilst the information is considered to be true and
correct at the date of publication, changes in circumstances after the time of publication may impact on the accuracy of the information.
The information may change without notice and the State of New South Wales is not in any way liable for the accuracy of any information
printed an
d stored or in any way interpreted and used by a user.
MEDICATION SAFETY COMMUNICATION
Information for health professionals in NSW public health organisations
Main therapeutic applications
MS Contin (granules for) suspension is a sustained release formulation of morphine sulfate, an opioid analgesic
indicated for the management of severe pain where other treatment options have failed, are contraindicated, not
tolerated or are otherwise inappropriate to provide sufficient management. Additionally, the pain should be opioid-
responsive and severe enough to require daily, continuous, long-term treatment. In practice, MS Contin (granules
for) suspension are generally used for patients with swallowing difficulties and/or those with enteral feeding tubes.
Alternative agents
Alternative opioid analgesics that can be considered based on the patient’s clinical condition and prescriber’s
preference may include –
• Sustained release: MS Mono (24-hourly dosing) and Kapanol (12- or 24-hourly dosing) capsules (morphine
sulfate) – not suitable for nasogastric tubes and should only be used for gastrostomy tubes 16 French or
larger. See Australian Don’t Rush to Crush Handbook for further information. Note – pellets (from inside the
caps
ules) should not be crushed, chewed or broken. The use of part/divided doses removed from a capsule
can lead to inaccurate dosing and is not recommended.
• Immediate release: Ordine oral solution (morphine hydrochloride), Anamorph and Sevredol tablets (morphine
sulfate), which can be crushed – require more frequent administration within a 24-hour period when compared
to sustained release formulations.
• Immediate release: Methadone oral liquid – for patients with enteral feeding tubes, see Australian Don’t Rush
to Crush Handbook for further information. Methadone can prolong QT interval and has a long half-life; dose
conversion should only be managed by practitioners experienced in its use.
• Transdermal opioid preparations such as buprenorphine and fentanyl patches.
• Inj
ectable opioid preparations.
Precautions and safety issues associated with alternative products
There is no direct substitute available for MS Contin (granules for) suspension and thus choice of alternative agent
should be made on a case-by-case basis. Different preparations of sustained release morphine may not be
bioequivalent – doses may need to be titrated to response. Referral to a pain or opioid stewardship specialist
may be required to ensure dose conversion is performed accurately.
Impacts of this communication on clinical practice
Existing patients utilising MS Contin (granules for) suspension should be reviewed and switched to an appropriate
alternative morphine or non-morphine agent(s). Dose equivalence must be calculated using the Opioid Calculator
from Faculty of Pain Medicine, a tool expressing equianalgesic dose as total oral Morphine Equivalent Daily Dose
(oMEDD), or evidence-based dose equivalent tables (e.g. AMH 2021, eTG 2020). Monitoring will be required until
stabilising of dosing on an alternative opioid. Patients should not be commenced
on this medication due to
uncertainty regarding the availability of ongoing supply during 2021.
Associated regulatory or policy issues
PD2013_043 Medication Handling in NSW Public Health Facilities
PD2020_045 High-Risk Medication Management
Key contacts
Clinical Excellence Commission (Medication Safety) – CEC-MedicationS[email protected].gov.au
MS Contin (granules for) suspension – 16 February 2021
Details of affected product(s)
MS Contin (granules for) suspension 20 mg – ARTG 45838
MS Contin (granules for) suspension 30 mg – ARTG 45841
MS Contin (granules for) suspension 60 mg – ARTG 65397
MS Contin (granules for) suspension 100 mg – ARTG 65398
MS Contin (granules for) suspension 200 mg – ARTG 65399
Reason for communication
Discontinuation, some strengths will be unavailable from March 2021 with
total run-out of stock by end of 2021
Date issue made apparent
October 2020
Estimated resolution date
Not applicable
