Morphine SR / MR

Strong Opioid·Analgesia - Opioids

Severe chronic pain, palliative care

S8Authority requiredPBSOPIOIDMS Contin, Kapanol+2

Max Dose

Titrated

Freq

BD Dosing

Do Not Crush

FATAL RISK

Renal Tox

HIGH RISK

Rapid Summary

Overview

Sustained-release oral morphine. Provides 12-hour baseline analgesia for severe chronic or cancer-related pain.

Maximum Dose

Titrated to effect.

Clinical Focus

Must never be crushed. Carries the same severe renal toxicity warnings as immediate-release morphine.

Bottom Line

Morphine SR / MR is a sustained-release formulation for chronic severe pain and palliative care, but must never be crushed and requires breakthrough IR morphine for incident pain management.

Formulation & Access

Brand Names

MS Contin, Kapanol

Oral Routes

Sustained-release tablets/capsules (5, 10, 15, 30, 60, 100 mg).

Prescribing & PBS

Highly Restricted (S8). Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Severe chronic pain, palliative care.

Clinical Place

Baseline analgesia in oncology and palliative care. Less frequently used for benign chronic pain due to modern preference for Tapentadol or Buprenorphine.

Quick reference

Class & Role

Strong Opioid — Sustained-release oral morphine.

Route / Formulation

Sustained-release tablets/capsules (5, 10, 15, 30, 60, 100 mg). (MS Contin, Kapanol)

Usual Dose & Max

Start PO 10-15 mg BD (strictly q12h). Titrate every 48 hours to effect. Titrated to effect.

Key Indication Doses

Chronic Pain: Start PO 10-15 mg BD (strictly q12h). Titrate every 48 hours to effect. Renal Impairment: Avoid if eGFR < 30 due to fatal accumulation of M3G/M6G metabolites. Switch to SR Hydromorphone (Jurnista) or a Fentanyl Patch.

Best Uses

Morphine SR / MR is a sustained-release formulation for chronic severe pain and palliative care, but must never be crushed and requires breakthrough IR morphine for incident pain management.

Avoid / Cautions

Renal failure, paralytic ileus, respiratory depression.

Key Risks

Respiratory: Apnoea if crushed or chewed. Gastrointestinal: Severe constipation. Neurological: Sedation, delirium, tolerance.

Key Interactions

Benzodiazepines (Synergistic respiratory arrest).

Monitoring

Ensure intact swallowing. Monitor RR and sedation. Check eGFR.

Clinical Pearl

While MS Contin tablets can never be broken, Kapanol capsules contain micro-pellets. The capsule can be opened and the pellets sprinkled on yogurt or down a feeding tube, provided the pellets themselves are not crushed. This is brilliant for dysphagic palliative patients.

Access

Authority requiredMS Contin, Kapanol100 mg tablet

Brand: MS Contin, Kapanol
PBS status: Authority required
Formulation: Sustained-release tablets/capsules (5, 10, 15, 30, 60, 100 mg)

Morphine SR / MR

Strong Opioid·Analgesia - Opioids

Severe chronic pain, palliative care

S8Authority requiredPBSOPIOIDMS Contin, Kapanol+2

Max Dose

Titrated

Freq

BD Dosing

Do Not Crush

FATAL RISK

Renal Tox

HIGH RISK

Rapid Summary

Overview

Sustained-release oral morphine. Provides 12-hour baseline analgesia for severe chronic or cancer-related pain.

Maximum Dose

Titrated to effect.

Clinical Focus

Must never be crushed. Carries the same severe renal toxicity warnings as immediate-release morphine.

Bottom Line

Morphine SR / MR is a sustained-release formulation for chronic severe pain and palliative care, but must never be crushed and requires breakthrough IR morphine for incident pain management.

Formulation & Access

Brand Names

MS Contin, Kapanol

Oral Routes

Sustained-release tablets/capsules (5, 10, 15, 30, 60, 100 mg).

Prescribing & PBS

Highly Restricted (S8). Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Severe chronic pain, palliative care.

Clinical Place

Baseline analgesia in oncology and palliative care. Less frequently used for benign chronic pain due to modern preference for Tapentadol or Buprenorphine.

Quick reference

Class & Role

Strong Opioid — Sustained-release oral morphine.

Route / Formulation

Sustained-release tablets/capsules (5, 10, 15, 30, 60, 100 mg). (MS Contin, Kapanol)

Usual Dose & Max

Start PO 10-15 mg BD (strictly q12h). Titrate every 48 hours to effect. Titrated to effect.

Key Indication Doses

Best Uses

Morphine SR / MR is a sustained-release formulation for chronic severe pain and palliative care, but must never be crushed and requires breakthrough IR morphine for incident pain management.

Avoid / Cautions

Renal failure, paralytic ileus, respiratory depression.

Key Risks

Respiratory: Apnoea if crushed or chewed. Gastrointestinal: Severe constipation. Neurological: Sedation, delirium, tolerance.

Key Interactions

Benzodiazepines (Synergistic respiratory arrest).

Monitoring

Ensure intact swallowing. Monitor RR and sedation. Check eGFR.

Clinical Pearl

Access

Authority requiredMS Contin, Kapanol100 mg tablet

Brand: MS Contin, Kapanol
PBS status: Authority required
Formulation: Sustained-release tablets/capsules (5, 10, 15, 30, 60, 100 mg)