Fentanyl 12 microgram per 1 hour Opiodur 12micrograms/hour
transdermal patches | 5 patch P £7.14 DT = £12.59b
Fentanyl 25 microgram per 1 hour Opiodur 25micrograms/hour
transdermal patches | 5 patch P £10.22 DT = £17.99b
Fentanyl 50 microgram per 1 hour Opiodur 50micrograms/hour
transdermal patches | 5 patch P £19.11 DT = £33.66b
Fentanyl 75 microgram per 1 hour Opiodur 75micrograms/hour
transdermal patches | 5 patch P £26.66 DT = £46.99b
Fentanyl 100 microgram per 1 hour Opiodur 100micrograms/hour
transdermal patches | 5 patch P £32.84 DT = £57.86b ▶ Osmanil (Zentiva)
Fentanyl 12 microgram per 1 hour Osmanil 12micrograms/hour
transdermal patches | 5 patch P £18.11 DT = £12.59b
Fentanyl 25 microgram per 1 hour Osmanil 25micrograms/hour
transdermal patches | 5 patch P £26.94 DT = £17.99b
Fentanyl 50 microgram per 1 hour Osmanil 50micrograms/hour
transdermal patches | 5 patch P £50.32 DT = £33.66b
Fentanyl 75 microgram per 1 hour Osmanil 75micrograms/hour
transdermal patches | 5 patch P £70.15 DT = £46.99b
Fentanyl 100 microgram per 1 hour Osmanil 100micrograms/hour
transdermal patches | 5 patch P £86.46 DT = £57.86b ▶ Victanyl (Actavis UK Ltd)
Fentanyl 12 microgram per 1 hour Victanyl 12micrograms/hour
transdermal patches | 5 patch P £12.58 DT = £12.59b
Fentanyl 25 microgram per 1 hour Victanyl 25micrograms/hour
transdermal patches | 5 patch P £25.89 DT = £17.99b
Fentanyl 50 microgram per 1 hour Victanyl 50micrograms/hour
transdermal patches | 5 patch P £48.36 DT = £33.66b
Fentanyl 75 microgram per 1 hour Victanyl 75micrograms/hour
transdermal patches | 5 patch P £67.41 DT = £46.99b
Fentanyl 100 microgram per 1 hour Victanyl 100micrograms/hour
transdermal patches | 5 patch P £83.09 DT = £57.86b ▶ Yemex (Sandoz Ltd)
Fentanyl 12 microgram per 1 hour Yemex 12micrograms/hour
transdermal patches | 5 patch P £12.59 DT = £12.59b
Fentanyl 25 microgram per 1 hour Yemex 25micrograms/hour
transdermal patches | 5 patch P £17.99 DT = £17.99b
Fentanyl 50 microgram per 1 hour Yemex 50micrograms/hour
transdermal patches | 5 patch P £33.66 DT = £33.66b
Fentanyl 75 microgram per 1 hour Yemex 75micrograms/hour
transdermal patches | 5 patch P £46.99 DT = £46.99b
Fentanyl 100 microgram per 1 hour Yemex 100micrograms/hour
transdermal patches | 5 patch P £57.86 DT = £57.86b
CAUTIONARY AND ADVISORY LABELS 2
EXCIPIENTS: May contain Propylene glycol
Fentanyl (as Fentanyl citrate) 200 microgram Cynril
200microgram lozenges with integral oromucosal applicator | 3 lozenge P £21.05 DT = £21.05b
Fentanyl (as Fentanyl citrate) 400 microgram Cynril
400microgram lozenges with integral oromucosal applicator | 3 lozenge P £21.05 DT = £21.05b
Fentanyl (as Fentanyl citrate) 600 microgram Cynril
600microgram lozenges with integral oromucosal applicator |
3 lozenge P £21.05 DT = £21.05b
Fentanyl (as Fentanyl citrate) 800 microgram Cynril
800microgram lozenges with integral oromucosal applicator | 3 lozenge P £21.05 DT = £21.05b
Fentanyl (as Fentanyl citrate) 1.2 mg Cynril 1.2mg lozenges with
integral oromucosal applicator | 3 lozenge P £21.05 DT =
Fentanyl (as Fentanyl citrate) 1.6 mg Cynril 1.6mg lozenges with
integral oromucosal applicator | 3 lozenge P £21.05 DT =
Fentanyl (as Fentanyl citrate) 200 microgram Actiq
200microgram lozenges with integral oromucosal applicator |
3 lozenge P £21.05 DT = £21.05b | 30 lozenge P £210.41
Fentanyl (as Fentanyl citrate) 400 microgram Actiq
Fentanyl (as Fentanyl citrate) 600 microgram Actiq
Fentanyl (as Fentanyl citrate) 800 microgram Actiq
Fentanyl (as Fentanyl citrate) 1.2 mg Actiq 1.2mg lozenges with
integral oromucosal applicator | 3 lozenge P £21.05 DT =
£21.05b | 30 lozenge P £210.41 DT = £210.41b
Fentanyl (as Fentanyl citrate) 1.6 mg Actiq 1.6mg lozenges with
integral oromucosal applicator | 3 lozenge P £21.05 DT =
£21.05b | 30 lozenge P £210.41 DT = £210.41b
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 1.3 mg every 4 hours, dose to be
increased if necessary according to severity of pain
▶ Adult: 1.3 mg every 4 hours, dose to be increased if
necessary according to severity of pain
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Child 12–17 years: 4 mg every 12 hours, dose to be
increased if necessary according to severity of pain
▶ Adult: 4 mg every 12 hours, dose to be increased if
necessary according to severity of pain
l CONTRA-INDICATIONS Acute abdomen
l CAUTIONS Pancreatitis .toxic psychosis
l INTERACTIONS → Appendix 1: opioids
▶ Common or very common Abdominal pain . anxiety . appetite decreased . asthenia . sleep disorders
▶ Uncommon Depression . diarrhoea . dyspnoea . erectile
dysfunction . malaise . movement disorders . paraesthesia . peripheral oedema .taste altered .tremor
▶ Frequency not known Hyperalgesia . paralytic ileus . seizure . withdrawal syndrome neonatal
l BREAST FEEDING Avoid—no information available.
l HEPATIC IMPAIRMENT Manufacturer advises avoid.
l RENAL IMPAIRMENT Avoid use or reduce dose; opioid
effects increased and prolonged and increased cerebral
l DIRECTIONS FOR ADMINISTRATION For immediate-release
capsules, swallow whole capsule or sprinkle contents on
soft food. For modified-release capsules, swallow whole or
open capsule and sprinkle contents on soft cold food
(swallow the pellets within the capsule whole; do not crush
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer hydromorphone
hydrochloride capsules and modified-release capsules.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral solution
CAUTIONARY AND ADVISORY LABELS 2
▶ Palladone SR (Napp Pharmaceuticals Ltd)
Hydromorphone hydrochloride 2 mg Palladone SR 2mg capsules |
56 capsule P £20.98 DT = £20.98b
Hydromorphone hydrochloride 4 mg Palladone SR 4mg capsules | 56 capsule P £28.75 DT = £28.75b
Hydromorphone hydrochloride 8 mg Palladone SR 8mg capsules | 56 capsule P £56.08 DT = £56.08b
Hydromorphone hydrochloride 16 mg Palladone SR 16mg capsules
| 56 capsule P £106.53 DT = £106.53b
Hydromorphone hydrochloride 24 mg Palladone SR 24mg capsules
| 56 capsule P £159.82 DT = £159.82b
CAUTIONARY AND ADVISORY LABELS 2
▶ Palladone (Napp Pharmaceuticals Ltd)
Hydromorphone hydrochloride 1.3 mg Palladone 1.3mg capsules
| 56 capsule P £8.82 DT = £8.82b
Hydromorphone hydrochloride 2.6 mg Palladone 2.6mg capsules
| 56 capsule P £17.64 DT = £17.64b
Moderate to severe pain, including post-operative pain
▶ Adult: 200 mg every 3–6 hours as required
▶ Adult: 75–100 mg every 2–4 hours if required
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 50–100 mg every 2–4 hours if required
▶ Adult: 2 mg/kg, usual dose 100–150 mg
l CONTRA-INDICATIONS Myocardial infarction . phaeochromocytoma
l INTERACTIONS → Appendix 1: opioids
▶ Common or very common Diarrhoea . gastrointestinal
Overdose Effects only partially reversed by naloxone.
l BREAST FEEDING Use only if potential benefit outweighs
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Dose adjustments Manufacturer advises dose reduction.
l RENAL IMPAIRMENT Avoid use or reduce dose; opioid
effects increased and prolonged and increased cerebral
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Meptazinol (as Meptazinol hydrochloride) 100 mg per
1 ml Meptid 100mg/1ml solution for injection ampoules | 10 ampoule P £19.21
CAUTIONARY AND ADVISORY LABELS 2
Meptazinol (as Meptazinol hydrochloride) 200 mg Meptid 200mg
tablets | 112 tablet P £22.11 DT = £22.11
▶ Child 1–5 months: Initially 100–200 micrograms/kg
every 6 hours, adjusted according to response
▶ Child 6 months–1 year: Initially 100–200 micrograms/kg
every 4 hours, adjusted according to response
▶ Child 2–11 years: Initially 200 micrograms/kg every
4 hours, adjusted according to response
▶ Child 12–17 years: Initially 2.5–10 mg every 4 hours,
adjusted according to response
▶ INITIALLY BY INTRAVENOUS INJECTION
▶ Child 1–5 months: 100 micrograms/kg every 6 hours,
adjusted according to response, dose to be
administered over at least 5 minutes, alternatively (by
intravenous injection) initially 100 micrograms/kg,
dose to be administered over at least 5 minutes,
followed by (by continuous intravenous infusion)
10–30 micrograms/kg/hour, adjusted according to
▶ Child 6 months–11 years: 100 micrograms/kg every
4 hours, adjusted according to response, dose to be
administered over at least 5 minutes, alternatively (by
intravenous injection) initially 100 micrograms/kg,
dose to be administered over at least 5 minutes,
followed by (by continuous intravenous infusion)
20–30 micrograms/kg/hour, adjusted according to
▶ Child 12–17 years: 5 mg every 4 hours, adjusted
according to response, dose to be administered over at
least 5 minutes, alternatively (by intravenous
injection) initially 5 mg, dose to be administered over
at least 5 minutes, followed by (by continuous
intravenous infusion) 20–30 micrograms/kg/hour,
adjusted according to response
▶ Child 1–2 months: Initially 50–100 micrograms/kg every
4 hours, adjusted according to response
▶ Child 3–5 months: 100–150 micrograms/kg every
4 hours, adjusted according to response
▶ Child 6–11 months: 200 micrograms/kg every 4 hours,
adjusted according to response
▶ Child 1 year: Initially 200–300 micrograms/kg every
4 hours, adjusted according to response
▶ Child 2–11 years: Initially 200–300 micrograms/kg every
4 hours (max. per dose 10 mg), adjusted according to
▶ Child 12–17 years: Initially 5–10 mg every 4 hours,
adjusted according to response
▶ BY MOUTH, OR BY SUBCUTANEOUS INJECTION, OR BY
▶ Adult: Initially 10 mg every 4 hours, adjusted according
to response, subcutaneous injection not suitable for
oedematous patients, dose can be given more
frequently during titration, use dose for elderly in frail
▶ Elderly: Initially 5 mg every 4 hours, adjusted according
to response, subcutaneous injection not suitable for
oedematous patients, dose can be given more
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: Initially 5 mg every 4 hours, adjusted according
to response, dose can be adjusted more frequently
during titration, reduced dose recommended in frail
▶ BY MOUTH, OR BY SUBCUTANEOUS INJECTION, OR BY
▶ Adult: Initially 5–10 mg every 4 hours, adjusted
according to response, subcutaneous injection not
suitable for oedematous patients
▶ Adult: Initially 15–30 mg every 4 hours, adjusted
Pain (with modified-release 12-hourly preparations)
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Every 12 hours, dose adjusted according to daily
morphine requirements, dosage requirements should
be reviewed if the brand is altered
Pain (with modified-release 24-hourly preparations)
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Every 24 hours, dose adjusted according to daily
morphine requirements, dosage requirements should
be reviewed if the brand is altered
Pain management in palliative care (starting dose for
▶ Adult: 20–30 mg daily in divided doses, using
immediate-release preparation 4-hourly or a 12-hourly
modified-release preparation, for continued→
management of breakthrough pain and other general
advice, see Pain management with opioids under
Prescribing in palliative care p. 25.
Pain management in palliative care (starting dose for
patients being switched from a regular weak opioid)
▶ Adult: 40–60 mg daily in divided doses, using
immediate-release preparation 4-hourly or 12-hourly
modified-release preparation, for management of
breakthrough pain and other general advice, see Pain
management with opioids under Prescribing in palliative
Pain in palliative care (following initial titration)
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Usual dose 30 mg every 4 hours; up to 200 mg
every 4 hours, higher dose may be required for some
patients (occasionally more is needed); for
management of breakthrough pain and other general
advice, see Pain management with opioids under p. 25.
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Usual dose 100 mg every 12 hours; up to 600 mg
every 12 hours, higher dose may be required for some
patients (occasionally more is needed); for
management of breakthrough pain and other general
advice, see Pain management with opioids under p. 25.
▶ Adult: Initially 5 mg every 4 hours
▶ BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
▶ Adult: Up to 10 mg, dose to be administered
60–90 minutes before operation
Patient controlled analgesia (PCA)
▶ Adult: (consult local protocol)
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 5–10 mg, followed by 5–10 mg if required, dose
to be administered at a rate of 1–2 mg/minute, use
dose for elderly in frail patients
▶ Elderly: 2.5–5 mg, followed by 2.5–5 mg if required,
dose to be administered at a rate of 1–2 mg/minute
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 5–10 mg, dose to be administered at a rate of
2 mg/minute, use dose for elderly in frail patients
▶ Elderly: 2.5–5 mg, dose to be administered at a rate of
Dyspnoea at rest in palliative care
▶ Adult: Initially 5 mg every 4 hours, to be given in
DOSE EQUIVALENCE AND CONVERSION
▶ The doses stated refer equally to morphine
l UNLICENSED USE Oramorph ® solution and MXL ® capsules
not licensed for use in children under 1 year. Sevredol ®
tablets not licensed for use in children under 3 years.
Oramorph ® unit dose vials and Filnarine ® SR tablets not
licensed for use in children under 6 years. MST Continus ®
preparations licensed to treat children with cancer pain
(age-range not specified by manufacturer).
▶ With rectal use in children Suppositories are not licensed for
Do not confuse modified-release 12-hourly preparations
with 24-hourly preparations, see Prescribing and
l CONTRA-INDICATIONS Acute abdomen . delayed gastric
emptying . heart failure secondary to chronic lung disease . phaeochromocytoma
l CAUTIONS Cardiac arrhythmias . pancreatitis . severe cor
l INTERACTIONS → Appendix 1: opioids
▶ With oral use Agitation . bronchospasm . ileus . mood
altered . myoclonus . peripheral oedema . pulmonary
oedema . seizure . sensation abnormal . syncope .taste
spasm . urinary disorders . vision disorders
l BREAST FEEDING Therapeutic doses unlikely to affect
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Avoid oral preparations in acute impairment; for injectable
preparations—consult product literature.
Dose adjustments Manufacturer advises consider dose
reduction—consult product literature.
l RENAL IMPAIRMENT Avoid use or reduce dose; opioid
effects increased and prolonged; increased cerebral
l MONITORING REQUIREMENTS Possible association
between acute chest syndrome in patients with sickle cell
disease treated with morphine during a vaso-occlusive
crisis—manufacturer advises close monitoring for acute
chest syndrome symptoms during treatment.
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use in children For continuous intravenous
infusion, dilute with Glucose 5% or 10% or Sodium
▶ With oral use For modified release capsules—swallow whole
or open capsule and sprinkle contents on soft food.
l PRESCRIBING AND DISPENSING INFORMATION Modifiedrelease preparations are available as 12-hourly or
24-hourly formulations; prescribers must ensure that the
correct preparation is prescribed. Preparations that should
be given 12-hourly include Filnarine ® SR, MST Continus ®,
Morphgesic ® SR and Zomorph ®. Preparations that should
be given 24-hourly include MXL ®.
Prescriptions must specify the ‘form’.
▶ With rectal use Both the strength of the suppositories and
the morphine salt contained in them must be specified by
Palliative care For further information on the use of
morphine in palliative care, see www.medicinescomplete.
com/#/content/palliative/morphine.
▶ With oral use Patients or carers should be given advice on
how to administer morphine modified-release capsules.
Medicines for Children leaflet: Morphine for pain
www.medicinesforchildren.org.uk/morphine-pain
l EXCEPTIONS TO LEGAL CATEGORY
Morphine Oral Solutions Prescription-only medicines or
schedule 2 controlled drug. The proportion of morphine
hydrochloride may be altered when specified by the
prescriber; if above 13 mg per 5 mL the solution becomes a
schedule 2 controlled drug. It is usual to adjust the
strength so that the dose volume is 5 or 10 mL.
Oral solutions of morphine can be prescribed by writing
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: capsule, oral
solution, solution for injection, infusion, solution for infusion,
CAUTIONARY AND ADVISORY LABELS 2, 25
▶ MST Continus (Napp Pharmaceuticals Ltd)
Morphine sulfate 5 mg MST Continus 5mg tablets | 60 tablet P £3.29 DT = £3.29b
Morphine sulfate 10 mg MST Continus 10mg tablets | 60 tablet P £5.20 DT = £5.20b
Morphine sulfate 15 mg MST Continus 15mg tablets | 60 tablet P £9.10 DT = £9.10b
Morphine sulfate 30 mg MST Continus 30mg tablets | 60 tablet P £12.47 DT = £12.47b
Morphine sulfate 60 mg MST Continus 60mg tablets | 60 tablet P £24.32 DT = £24.32b
Morphine sulfate 100 mg MST Continus 100mg tablets |
60 tablet P £38.50 DT = £38.50b
Morphine sulfate 10 mg Morphgesic SR 10mg tablets | 60 tablet P £3.85 DT = £5.20b
Morphine sulfate 30 mg Morphgesic SR 30mg tablets | 60 tablet P £9.24 DT = £12.47b
Morphine sulfate 60 mg Morphgesic SR 60mg tablets |
60 tablet P £18.04 DT = £24.32b
Morphine sulfate 100 mg Morphgesic SR 100mg tablets | 60 tablet P £28.54 DT = £38.50b
CAUTIONARY AND ADVISORY LABELS 2
▶ Sevredol (Napp Pharmaceuticals Ltd)
Morphine sulfate 10 mg Sevredol 10mg tablets | 56 tablet P £5.31 DT = £5.31b
Morphine sulfate 20 mg Sevredol 20mg tablets | 56 tablet P £10.61 DT = £10.61b
Morphine sulfate 50 mg Sevredol 50mg tablets | 56 tablet P £28.02 DT = £28.02b
CAUTIONARY AND ADVISORY LABELS 2
Morphine sulfate 10 mg Morphine sulfate 10mg suppositories | 12 suppository P £19.45 DT = £19.45b
Morphine sulfate 1 mg per 1 ml Morphine sulfate 5mg/5ml solution
for injection ampoules | 10 ampoule P £44.00 DT = £44.00b
Morphine sulfate 1mg/1ml solution for injection ampoules | 10 ampoule P £31.90b
Morphine sulfate 10mg/10ml solution for injection ampoules | 10 ampoule P £15.00b
Morphine sulfate 10 mg per 1 ml Morphine sulfate 10mg/1ml
solution for injection ampoules | 10 ampoule P £12.96 DT =
Morphine sulfate 15 mg per 1 ml Morphine sulfate 15mg/1ml
solution for injection ampoules | 10 ampoule P £10.74–£13.10 DT
Morphine sulfate 20 mg per 1 ml Morphine sulfate 20mg/1ml
solution for injection ampoules | 10 ampoule P £65.67 DT =
Morphine sulfate 30 mg per 1 ml Morphine sulfate 30mg/1ml
solution for injection ampoules | 10 ampoule P £14.02 DT =
Morphine sulfate 60mg/2ml solution for injection ampoules |
5 ampoule P £10.07 DT = £10.07b
CAUTIONARY AND ADVISORY LABELS 2
▶ MXL (Napp Pharmaceuticals Ltd)
Morphine sulfate 30 mg MXL 30mg capsules | 28 capsule P £10.91b
Morphine sulfate 60 mg MXL 60mg capsules | 28 capsule P £14.95b
Morphine sulfate 90 mg MXL 90mg capsules | 28 capsule P £22.04 DT = £22.04b
Morphine sulfate 120 mg MXL 120mg capsules | 28 capsule P £29.15 DT = £29.15b
Morphine sulfate 150 mg MXL 150mg capsules | 28 capsule P £36.43 DT = £36.43b
Morphine sulfate 200 mg MXL 200mg capsules | 28 capsule P £46.15b ▶ Zomorph (Ethypharm UK Ltd)
Morphine sulfate 10 mg Zomorph 10mg modified-release capsules
| 60 capsule P £3.47 DT = £3.47b
Morphine sulfate 30 mg Zomorph 30mg modified-release capsules
| 60 capsule P £8.30 DT = £8.30b
Morphine sulfate 60 mg Zomorph 60mg modified-release capsules
| 60 capsule P £16.20 DT = £16.20b
Morphine sulfate 100 mg Zomorph 100mg modified-release
capsules | 60 capsule P £21.80 DT = £21.80b
Morphine sulfate 200 mg Zomorph 200mg modified-release
capsules | 60 capsule P £43.60 DT = £43.60b
Morphine sulfate 1 mg per 1 ml Morphine sulfate 50mg/50ml
solution for infusion vials | 1 vial P £5.78 DT = £5.78b | 10 vial P £40.80b
Morphine sulfate 2 mg per 1 ml Morphine sulfate 100mg/50ml
solution for infusion vials | 1 vial P £6.48b | 10 vial P £64.80b
CAUTIONARY AND ADVISORY LABELS 2
Morphine sulfate 2 mg per 1 ml Morphine sulfate 10mg/5ml oral
solution | 100 ml P £1.68–£1.82m | 300 ml P £6.54 DT =
£5.32m | 500 ml P £7.10–£9.10m ▶ Oramorph (Boehringer Ingelheim Ltd)
Morphine sulfate 2 mg per 1 ml Oramorph 10mg/5ml oral solution
| 100 ml P £1.89m | 300 ml P £5.45 DT = £5.32m | 500 ml P £8.50m
Morphine sulfate 20 mg per 1 ml Oramorph 20mg/ml concentrated
oral solution sugar-free | 120 ml P £19.50 DT = £19.50b
CAUTIONARY AND ADVISORY LABELS 2, 13
▶ MST Continus (Napp Pharmaceuticals Ltd)
Morphine sulfate 20 mg MST Continus suspension 20mg granules
sachets sugar-free | 30 sachet P £24.58 DT = £24.58b
Morphine sulfate 30 mg MST Continus suspension 30mg granules
sachets sugar-free | 30 sachet P £25.54 DT = £25.54b
Morphine sulfate 60 mg MST Continus suspension 60mg granules
sachets sugar-free | 30 sachet P £51.09 DT = £51.09b
Morphine sulfate 100 mg MST Continus suspension 100mg granules
sachets sugar-free | 30 sachet P £85.15 DT = £85.15b
Morphine sulfate 200 mg MST Continus suspension 200mg granules
sachets sugar-free | 30 sachet P £170.30 DT = £170.30b
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, morphine p. 463, cyclizine p. 430.
Moderate to severe pain (short-term use only)
▶ BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION, OR BY INTRAVENOUS INJECTION
▶ Adult: 1 mL, do not repeat dose more often than every
4 hours; maximum 3 doses per day
Moderate to severe pain (short-term use only)
▶ BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION, OR BY INTRAVENOUS INJECTION
▶ Adult: 1 mL, do not repeat dose more often than every
4 hours; maximum 3 doses per day
l CAUTIONS Myocardial infarction (cyclizine may aggravate
severe heart failure and counteract the haemodynamic
benefits of opioids). not recommended in palliative care
l INTERACTIONS → Appendix 1: antihistamines, sedating . opioids
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Morphine tartrate 15 mg per 1 ml, Cyclizine tartrate 50 mg per
1 ml Cyclimorph 15 solution for injection 1ml ampoules | 5 ampoule P £9.12b
Morphine tartrate 10 mg per 1 ml, Cyclizine tartrate 50 mg per
1 ml Cyclimorph 10 solution for injection 1ml ampoules | 5 ampoule P £8.77b
Oxycodone hydrochloride 19-May-2017
Postoperative pain | Severe pain
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 5 mg every 4–6 hours, dose to be
increased if necessary according to severity of pain,
some patients may require higher doses than the
maximum daily dose; maximum 400 mg per day
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Initially 10 mg every 12 hours (max. per dose
200 mg every 12 hours), dose to be increased if
necessary according to severity of pain, some patients
might require higher doses than the maximum daily
dose, use 12-hourly modified-release preparations for
this dose; see Prescribing and dispensing information
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1–10 mg every 4 hours as required
▶ Adult: Initially 2 mg/hour, adjusted according to
▶ Adult: Initially 5 mg every 4 hours as required
▶ Adult: Initially 7.5 mg/24 hours, adjusted according to
Patient controlled analgesia (PCA)
▶ Adult: (consult local protocol)
Moderate to severe pain in palliative care
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 5 mg every 4–6 hours, dose to be
increased if necessary according to severity of pain,
some patients may require higher doses than the
maximum daily dose; maximum 400 mg per day
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: Initially 10 mg every 12 hours (max. per dose
200 mg every 12 hours), dose to be increased if
necessary according to severity of pain, some patients
might require higher doses than the maximum daily
dose, use 12-hourly modified-release preparations for
this dose; see Prescribing and dispensing information
▶ BY SLOW INTRAVENOUS INJECTION
▶ Adult: 1–10 mg every 4 hours as required
▶ Adult: Initially 2 mg/hour, adjusted according to
▶ Adult: Initially 5 mg every 4 hours as required
▶ Adult: Initially 7.5 mg/24 hours, adjusted according to
DOSE EQUIVALENCE AND CONVERSION
▶ 2 mg oral oxycodone is approximately equivalent to
▶ Adult: Initially 10 mg every 24 hours, dose to be
increased if necessary according to severity of pain,
some patients may require higher doses than the
maximum daily dose; maximum 400 mg per day
Do not confuse modified-release 12-hourly preparations
with 24-hourly preparations, see Prescribing and
l CONTRA-INDICATIONS Acute abdomen . chronic
constipation . cor pulmonale . delayed gastric emptying
l CAUTIONS Pancreatitis .toxic psychosis
l INTERACTIONS → Appendix 1: opioids
discomfort. hiccups . mood altered .tremor
▶ Frequency not known Aggression . amenorrhoea . cholestasis
▶ With parenteral use Appetite decreased . asthenia . cough
decreased . sleep disorders .thinking abnormal
▶ With oral use Chest pain . cough . hyperacusia . increased
▶ With parenteral use Fever. hypogonadism . ureteral spasm
▶ With oral use Haemorrhage . lymphadenopathy . muscle
spasms . photosensitivity reaction .tooth discolouration . weight changes
▶ With parenteral use Dental caries . hyperalgesia . withdrawal
l BREAST FEEDING Present in milk—avoid.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild impairment; avoid in moderate to severe impairment.
Dose adjustments Manufacturer advises initial dose
reduction of 50% in mild impairment; adjust according to
l RENAL IMPAIRMENT Opioid effects increased and
prolonged and increased cerebral sensitivity occurs. Avoid
if eGFR less than 10 mL/minute/1.73 m2
Dose adjustments Max. initial dose 2.5 mg every 6 hours in
patients not currently treated with an opioid with mild to
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous infusion (Oxynorm®),
give continuously or intermittently in Glucose 5% or
Sodium chloride 0.9%; dilute to a concentration of
l PRESCRIBING AND DISPENSING INFORMATION Modifiedrelease preparations are available as 12-hourly or
24-hourly formulations. Preparations that should be given
12-hourly include Abtard ®, Carexil ®, Ixyldone ®, Leveraxo ®,
Longtec ®, Oxeltra ®, OxyContin ®, Oxypro ®, Oxylan ®,
Reltebon ®, and Renocontin ®. Preparations that should be
given 24-hourly include Onexila ® XL.
Palliative care For further information on the use of
oxycodone in palliative care, see www.medicinescomplete.
com/#/content/palliative/oxycodone.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (October
2004 and November 2010) that OxyNorm® injection is
restricted for use within NHS Scotland for patients with
cancer who have difficulty in tolerating morphine or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral solution,
CAUTIONARY AND ADVISORY LABELS 2, 25
Oxycodone hydrochloride 5 mg Abtard 5mg modified-release
tablets | 28 tablet P £6.26 DT = £12.52b
Oxycodone hydrochloride 10 mg Abtard 10mg modified-release
tablets | 56 tablet P £12.52 DT = £25.04b
Oxycodone hydrochloride 15 mg Abtard 15mg modified-release
tablets | 56 tablet P £19.06 DT = £38.12b
Oxycodone hydrochloride 20 mg Abtard 20mg modified-release
tablets | 56 tablet P £25.04 DT = £50.08b
Oxycodone hydrochloride 30 mg Abtard 30mg modified-release
tablets | 56 tablet P £38.11 DT = £76.23b
Oxycodone hydrochloride 40 mg Abtard 40mg modified-release
tablets | 56 tablet P £50.09 DT = £100.19b
Oxycodone hydrochloride 60 mg Abtard 60mg modified-release
tablets | 56 tablet P £76.24 DT = £152.49b
Oxycodone hydrochloride 80 mg Abtard 80mg modified-release
tablets | 56 tablet P £100.19 DT = £200.39b ▶ Carexil (Sandoz Ltd)
Oxycodone hydrochloride 5 mg Carexil 5mg modified-release
tablets | 28 tablet P £6.26 DT = £12.52b
Oxycodone hydrochloride 10 mg Carexil 10mg modified-release
tablets | 56 tablet P £12.52 DT = £25.04b
Oxycodone hydrochloride 20 mg Carexil 20mg modified-release
tablets | 56 tablet P £25.04 DT = £50.08b
Oxycodone hydrochloride 40 mg Carexil 40mg modified-release
tablets | 56 tablet P £60.11 DT = £100.19b
Oxycodone hydrochloride 80 mg Carexil 80mg modified-release
tablets | 56 tablet P £120.23 DT = £200.39b
▶ Ixyldone (Morningside Healthcare Ltd)
Oxycodone hydrochloride 5 mg Ixyldone 5mg modified-release
tablets | 28 tablet P £4.40 DT = £12.52b
Oxycodone hydrochloride 10 mg Ixyldone 10mg modified-release
tablets | 56 tablet P £8.80 DT = £25.04b
Oxycodone hydrochloride 15 mg Ixyldone 15mg modified-release
tablets | 56 tablet P £13.40 DT = £38.12b
Oxycodone hydrochloride 20 mg Ixyldone 20mg modified-release
tablets | 56 tablet P £17.65 DT = £50.08b
Oxycodone hydrochloride 30 mg Ixyldone 30mg modified-release
tablets | 56 tablet P £26.85 DT = £76.23b
Oxycodone hydrochloride 40 mg Ixyldone 40mg modified-release
tablets | 56 tablet P £35.30 DT = £100.19b
Oxycodone hydrochloride 60 mg Ixyldone 60mg modified-release
tablets | 56 tablet P £53.70 DT = £152.49b
Oxycodone hydrochloride 80 mg Ixyldone 80mg modified-release
tablets | 56 tablet P £70.60 DT = £200.39b ▶ Leveraxo (Mylan)
Oxycodone hydrochloride 5 mg Leveraxo 5mg modified-release
tablets | 28 tablet P £12.39 DT = £12.52b
Oxycodone hydrochloride 10 mg Leveraxo 10mg modified-release
tablets | 56 tablet P £24.79 DT = £25.04b
Oxycodone hydrochloride 20 mg Leveraxo 20mg modified-release
tablets | 56 tablet P £49.58 DT = £50.08b
Oxycodone hydrochloride 30 mg Leveraxo 30mg modified-release
tablets | 56 tablet P £75.47 DT = £76.23b
Oxycodone hydrochloride 40 mg Leveraxo 40mg modified-release
tablets | 56 tablet P £99.19 DT = £100.19b
Oxycodone hydrochloride 60 mg Leveraxo 60mg modified-release
tablets | 56 tablet P £150.97 DT = £152.49b
Oxycodone hydrochloride 80 mg Leveraxo 80mg modified-release
tablets | 56 tablet P £198.39 DT = £200.39b ▶ Longtec (Qdem Pharmaceuticals Ltd)
Oxycodone hydrochloride 5 mg Longtec 5mg modified-release
tablets | 28 tablet P £6.26 DT = £12.52b
Oxycodone hydrochloride 10 mg Longtec 10mg modified-release
tablets | 56 tablet P £12.52 DT = £25.04b
Oxycodone hydrochloride 15 mg Longtec 15mg modified-release
tablets | 56 tablet P £19.06 DT = £38.12b
Oxycodone hydrochloride 20 mg Longtec 20mg modified-release
tablets | 56 tablet P £25.04 DT = £50.08b
Oxycodone hydrochloride 30 mg Longtec 30mg modified-release
tablets | 56 tablet P £38.11 DT = £76.23b
Oxycodone hydrochloride 40 mg Longtec 40mg modified-release
tablets | 56 tablet P £50.09 DT = £100.19b
Oxycodone hydrochloride 60 mg Longtec 60mg modified-release
tablets | 56 tablet P £76.24 DT = £152.49b
Oxycodone hydrochloride 80 mg Longtec 80mg modified-release
tablets | 56 tablet P £100.19 DT = £200.39b
Oxycodone hydrochloride 120 mg Longtec 120mg modified-release
tablets | 56 tablet P £152.51 DT = £305.02b ▶ Onexila XL (Aspire Pharma Ltd)
Oxycodone hydrochloride 10 mg Onexila XL 10mg tablets |
Oxycodone hydrochloride 20 mg Onexila XL 20mg tablets | 28 tablet P £12.52b
Oxycodone hydrochloride 40 mg Onexila XL 40mg tablets | 28 tablet P £25.04b
Oxycodone hydrochloride 5 mg Oxeltra 5mg modified-release
tablets | 28 tablet P £3.13 DT = £12.52b
Oxycodone hydrochloride 10 mg Oxeltra 10mg modified-release
tablets | 56 tablet P £6.26 DT = £25.04b
Oxycodone hydrochloride 15 mg Oxeltra 15mg modified-release
tablets | 56 tablet P £9.53 DT = £38.12b
Oxycodone hydrochloride 20 mg Oxeltra 20mg modified-release
tablets | 56 tablet P £12.52 DT = £50.08b
Oxycodone hydrochloride 30 mg Oxeltra 30mg modified-release
tablets | 56 tablet P £19.06 DT = £76.23b
Oxycodone hydrochloride 40 mg Oxeltra 40mg modified-release
tablets | 56 tablet P £25.05 DT = £100.19b
Oxycodone hydrochloride 60 mg Oxeltra 60mg modified-release
tablets | 56 tablet P £38.12 DT = £152.49b
Oxycodone hydrochloride 80 mg Oxeltra 80mg modified-release
tablets | 56 tablet P £50.10 DT = £200.39b ▶ OxyContin (Napp Pharmaceuticals Ltd)
Oxycodone hydrochloride 5 mg OxyContin 5mg modified-release
tablets | 28 tablet P £12.52 DT = £12.52b
Oxycodone hydrochloride 10 mg OxyContin 10mg modified-release
tablets | 56 tablet P £25.04 DT = £25.04b
Oxycodone hydrochloride 15 mg OxyContin 15mg modified-release
tablets | 56 tablet P £38.12 DT = £38.12b
Oxycodone hydrochloride 20 mg OxyContin 20mg modified-release
tablets | 56 tablet P £50.08 DT = £50.08b
Oxycodone hydrochloride 30 mg OxyContin 30mg modified-release
tablets | 56 tablet P £76.23 DT = £76.23b
Oxycodone hydrochloride 40 mg OxyContin 40mg modified-release
tablets | 56 tablet P £100.19 DT = £100.19b
Oxycodone hydrochloride 60 mg OxyContin 60mg modified-release
tablets | 56 tablet P £152.49 DT = £152.49b
Oxycodone hydrochloride 80 mg OxyContin 80mg modified-release
tablets | 56 tablet P £200.39 DT = £200.39b
Oxycodone hydrochloride 5 mg Oxylan 5mg modified-release
tablets | 28 tablet P £12.50 DT = £12.52b
Oxycodone hydrochloride 10 mg Oxylan 10mg modified-release
tablets | 56 tablet P £24.99 DT = £25.04b
Oxycodone hydrochloride 20 mg Oxylan 20mg modified-release
tablets | 56 tablet P £49.98 DT = £50.08b
Oxycodone hydrochloride 40 mg Oxylan 40mg modified-release
tablets | 56 tablet P £99.98 DT = £100.19b
Oxycodone hydrochloride 80 mg Oxylan 80mg modified-release
tablets | 56 tablet P £199.97 DT = £200.39b ▶ Oxypro (Ridge Pharma Ltd)
Oxycodone hydrochloride 5 mg Oxypro 5mg modified-release
tablets | 28 tablet P £3.13 DT = £12.52b
Oxycodone hydrochloride 10 mg Oxypro 10mg modified-release
tablets | 56 tablet P £6.26 DT = £25.04b
Oxycodone hydrochloride 15 mg Oxypro 15mg modified-release
tablets | 56 tablet P £9.53 DT = £38.12b
Oxycodone hydrochloride 20 mg Oxypro 20mg modified-release
tablets | 56 tablet P £12.52 DT = £50.08b
Oxycodone hydrochloride 30 mg Oxypro 30mg modified-release
tablets | 56 tablet P £19.06 DT = £76.23b
Oxycodone hydrochloride 40 mg Oxypro 40mg modified-release
tablets | 56 tablet P £25.05 DT = £100.19b
Oxycodone hydrochloride 60 mg Oxypro 60mg modified-release
tablets | 56 tablet P £38.12 DT = £152.49b
Oxycodone hydrochloride 80 mg Oxypro 80mg modified-release
tablets | 56 tablet P £50.10 DT = £200.39b ▶ Reltebon (Accord Healthcare Ltd)
Oxycodone hydrochloride 5 mg Reltebon 5mg modified-release
tablets | 28 tablet P £6.26 DT = £12.52b
Oxycodone hydrochloride 10 mg Reltebon 10mg modified-release
tablets | 56 tablet P £12.52 DT = £25.04b
Oxycodone hydrochloride 15 mg Reltebon 15mg modified-release
tablets | 56 tablet P £19.06 DT = £38.12b
Oxycodone hydrochloride 20 mg Reltebon 20mg modified-release
tablets | 56 tablet P £25.04 DT = £50.08b
Oxycodone hydrochloride 30 mg Reltebon 30mg modified-release
tablets | 56 tablet P £38.11 DT = £76.23b
Oxycodone hydrochloride 40 mg Reltebon 40mg modified-release
tablets | 56 tablet P £50.09 DT = £100.19b
Oxycodone hydrochloride 60 mg Reltebon 60mg modified-release
tablets | 56 tablet P £76.24 DT = £152.49b
Oxycodone hydrochloride 80 mg Reltebon 80mg modified-release
tablets | 56 tablet P £100.19 DT = £200.39b ▶ Renocontin (Glenmark Pharmaceuticals Europe Ltd)
Oxycodone hydrochloride 5 mg Renocontin 5mg modified-release
tablets | 28 tablet P £2.97 DT = £12.52b
▶ Oxycodone hydrochloride (Non-proprietary)
Oxycodone hydrochloride 10 mg per 1 ml Oxycodone 20mg/2ml
solution for injection ampoules | 5 ampoule P £16.00 DT =
£16.00b | 10 ampoule P £30.00b
Oxycodone 10mg/1ml solution for injection ampoules |
5 ampoule P £8.00 DT = £8.00b | 10 ampoule P £15.00b
Oxycodone hydrochloride 50 mg per 1 ml Oxycodone 50mg/1ml
solution for injection ampoules | 5 ampoule P £70.10 DT =
£70.10b | 10 ampoule P £135.00b ▶ OxyNorm (Napp Pharmaceuticals Ltd)
Oxycodone hydrochloride 10 mg per 1 ml OxyNorm 10mg/1ml
solution for injection ampoules | 5 ampoule P £8.00 DT =
OxyNorm 20mg/2ml solution for injection ampoules | 5 ampoule P £16.00 DT = £16.00b
Oxycodone hydrochloride 50 mg per 1 ml OxyNorm 50mg/1ml
solution for injection ampoules | 5 ampoule P £70.10 DT =
£70.10b ▶ Shortec (Qdem Pharmaceuticals Ltd)
Oxycodone hydrochloride 10 mg per 1 ml Shortec 20mg/2ml
solution for injection ampoules | 5 ampoule P £13.60 DT =
£16.00b Shortec 10mg/1ml solution for injection ampoules | 5 ampoule P £6.80 DT = £8.00b
Oxycodone hydrochloride 50 mg per 1 ml Shortec 50mg/1ml
solution for injection ampoules | 5 ampoule P £59.59 DT =
CAUTIONARY AND ADVISORY LABELS 2
▶ Oxycodone hydrochloride (Non-proprietary)
Oxycodone hydrochloride 1 mg per 1 ml Oxycodone 5mg/5ml oral
solution sugar free sugar-free | 250 ml P £9.71 DT = £9.71b
Oxycodone hydrochloride 10 mg per 1 ml Oxycodone 10mg/ml oral
solution sugar free sugar-free | 120 ml P £46.63 DT = £46.63b ▶ OxyNorm (Napp Pharmaceuticals Ltd)
Oxycodone hydrochloride 1 mg per 1 ml OxyNorm liquid 5mg/5ml
oral solution sugar-free | 250 ml P £9.71 DT = £9.71b
Oxycodone hydrochloride 10 mg per 1 ml OxyNorm 10mg/ml
concentrate oral solution sugar-free | 120 ml P £46.63 DT =
£46.63b ▶ Shortec (Qdem Pharmaceuticals Ltd)
Oxycodone hydrochloride 1 mg per 1 ml Shortec liquid 5mg/5ml
oral solution sugar-free | 250 ml P £8.25 DT = £9.71b
Oxycodone hydrochloride 10 mg per 1 ml Shortec 10mg/ml
concentrate oral solution sugar-free | 120 ml P £39.64 DT =
CAUTIONARY AND ADVISORY LABELS 2
Oxycodone hydrochloride 5 mg Lynlor 5mg capsules | 56 capsule P £6.86 DT = £11.43b
Oxycodone hydrochloride 10 mg Lynlor 10mg capsules |
56 capsule P £13.72 DT = £22.86b
Oxycodone hydrochloride 5 mg OxyNorm 5mg capsules | 56 capsule P £11.43 DT = £11.43b
Oxycodone hydrochloride 10 mg OxyNorm 10mg capsules | 56 capsule P £22.86 DT = £22.86b
Oxycodone hydrochloride 20 mg OxyNorm 20mg capsules |
56 capsule P £45.71 DT = £45.71b ▶ Shortec (Qdem Pharmaceuticals Ltd)
Oxycodone hydrochloride 5 mg Shortec 5mg capsules | 56 capsule P £6.86 DT = £11.43b
Oxycodone hydrochloride 10 mg Shortec 10mg capsules | 56 capsule P £13.72 DT = £22.86b
Oxycodone hydrochloride 20 mg Shortec 20mg capsules | 56 capsule P £27.43 DT = £45.71b
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