Kadian ER

Name: Kadian ER

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Commonly used brand name(s)

In the U.S.

Arymo ER
AVINza
Kadian
Kadian ER
Morphabond
Morphabond ER
MS Contin
Oramorph SR
Roxanol
Roxanol-T

Available Dosage Forms:

Capsule, Extended Release
Capsule, Extended Release, 24 HR
Solution
Tablet, Extended Release
Capsule
Tablet
Powder for Suspension, Extended Release
Capsule, Delayed Release
Syrup

Therapeutic Class: Analgesic

Chemical Class: Opioid

Uses For Kadian ER

Morphine is used to relieve moderate to severe pain. It belongs to the group of medicines called narcotic analgesics (pain medicines). Morphine acts on the central nervous system (CNS) to relieve pain.

Morphine extended-release capsules or tablets should not be used if you need pain medicine for just a short time, such as when recovering from surgery. Do not use this medicine to relieve mild pain, or in situations when non-narcotic medication is effective. This medicine should not be used to treat pain that you only have once in a while or "as needed".

When morphine is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only with your doctor's prescription.

Before Using Kadian ER

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of morphine in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of morphine in the elderly. However, elderly patients are more likely to have age-related lung, liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving morphine in order to avoid potentially serious side effects.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Nalmefene
Naltrexone
Safinamide

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abiraterone
Acepromazine
Alfentanil
Almotriptan
Alprazolam
Alvimopan
Amineptine
Amiodarone
Amisulpride
Amitriptyline
Amitriptylinoxide
Amobarbital
Amoxapine
Amphetamine
Anileridine
Aripiprazole
Asenapine
Azithromycin
Baclofen
Benperidol
Benzphetamine
Bromazepam
Bromopride
Brompheniramine
Buprenorphine
Buspirone
Butabarbital
Butorphanol
Captopril
Carbamazepine
Carbinoxamine
Carisoprodol
Carphenazine
Carvedilol
Chloral Hydrate
Chlordiazepoxide
Chlorpheniramine
Chlorpromazine
Chlorzoxazone
Cimetidine
Citalopram
Clarithromycin
Clobazam
Clomipramine
Clonazepam
Clorazepate
Clozapine
Cobicistat
Cocaine
Codeine
Conivaptan
Cyclobenzaprine
Cyclosporine
Desipramine
Desmopressin
Desvenlafaxine
Dexmedetomidine
Dextroamphetamine
Dextromethorphan
Dezocine
Diazepam
Dibenzepin
Dichloralphenazone
Difenoxin
Dihydrocodeine
Diltiazem
Diphenhydramine
Diphenoxylate
Dolasetron
Donepezil
Doxepin
Doxorubicin
Doxorubicin Hydrochloride Liposome
Doxylamine
Dronedarone
Droperidol
Duloxetine
Eletriptan
Enflurane
Erythromycin
Escitalopram
Estazolam
Eszopiclone
Ethchlorvynol
Ethopropazine
Ethylmorphine
Felodipine
Fentanyl
Flibanserin
Fluoxetine
Fluphenazine
Flurazepam
Fluspirilene
Fluvoxamine
Fospropofol
Frovatriptan
Furazolidone
Granisetron
Halazepam
Haloperidol
Halothane
Hexobarbital
Hydrocodone
Hydromorphone
Hydroxytryptophan
Hydroxyzine
Imipramine
Iproniazid
Isocarboxazid
Isoflurane
Itraconazole
Ivacaftor
Ketamine
Ketobemidone
Ketoconazole
Levomilnacipran
Levorphanol
Linezolid
Lisdexamfetamine
Lithium
Lofepramine
Lopinavir
Lorazepam
Lorcaserin
Loxapine
Meclizine
Melitracen
Melperone
Meperidine
Mephobarbital
Meprobamate
Meptazinol
Mesoridazine
Metaxalone
Methadone
Methamphetamine
Methdilazine
Methocarbamol
Methohexital
Methotrimeprazine
Methylene Blue
Methylnaltrexone
Midazolam
Milnacipran
Mirtazapine
Moclobemide
Molindone
Moricizine
Nalbuphine
Nalorphine
Naloxone
Naratriptan
Nefazodone
Nialamide
Nicomorphine
Nilotinib
Nitrazepam
Nitrous Oxide
Nortriptyline
Olanzapine
Ondansetron
Opipramol
Opium
Opium Alkaloids
Orphenadrine
Oxazepam
Oxycodone
Oxymorphone
Palonosetron
Papaveretum
Paregoric
Paroxetine
Pentazocine
Pentobarbital
Perampanel
Perazine
Periciazine
Perphenazine
Phenelzine
Phenobarbital
Pimozide
Piperacetazine
Pipotiazine
Piritramide
Prazepam
Primidone
Procarbazine
Prochlorperazine
Promazine
Promethazine
Propofol
Protriptyline
Quazepam
Quercetin
Quetiapine
Quinidine
Ramelteon
Ranolazine
Rasagiline
Remifentanil
Remoxipride
Ritonavir
Rizatriptan
Samidorphan
Secobarbital
Selegiline
Sertindole
Sertraline
Sibutramine
Simeprevir
Sodium Oxybate
St John's Wort
Sufentanil
Sulpiride
Sumatriptan
Sunitinib
Suvorexant
Tapentadol
Telaprevir
Temazepam
Thiethylperazine
Thiopental
Thiopropazate
Thioridazine
Tianeptine
Ticagrelor
Tilidine
Tizanidine
Tocophersolan
Tolonium Chloride
Topiramate
Tramadol
Tranylcypromine
Trazodone
Triazolam
Trifluoperazine
Trifluperidol
Triflupromazine
Trimeprazine
Trimipramine
Tryptophan
Venlafaxine
Verapamil
Vilazodone
Vortioxetine
Zaleplon
Ziprasidone
Zolmitriptan
Zolpidem
Zopiclone
Zotepine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Esmolol
Gabapentin
Gabapentin Enacarbil
Rifampin
Somatostatin
Yohimbine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Ethanol

Proper Use of morphine

This section provides information on the proper use of a number of products that contain morphine. It may not be specific to Kadian ER. Please read with care.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who may be more sensitive to the effects of pain medicines. If too much of this medicine is taken for a long time, it may become habit-forming (causing mental or physical dependence).

This medicine comes with a Medication Guide and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Avinza® is taken every 24 hours. Kadian® is taken every 12 or 24 hours at the same time each day. Morphabond™ is taken every 12 hours. Arymo™ ER is taken every 8 or 12 hours.

You may take this medicine with or without food.

Morphine extended-release capsules and tablets should only be used by patients who have already been taking narcotic pain medicines, also called opioids. These patients are called opioid-tolerant. If you are uncertain whether or not you are opioid-tolerant, check with your doctor before using this medicine.

Swallow the extended-release capsules and tablets whole. Do not crush, break, dissolve, or chew them. Do not use extended-release tablets that are broken.

If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of applesauce. Stir this mixture well and swallow it right away without chewing. Do not receive this medicine through a nasogastric tube.

While taking the extended-release tablet, part of the tablet may pass into your stool. This is normal and nothing to worry about.

Morphine extended-release capsules or tablets work differently from the regular morphine oral solution or tablets, even at the same dose. Do not switch from one brand or form to the other unless your doctor tells you to.

Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (extended-release capsules):
- For moderate to severe pain:
  - Adults—
    - The total amount of milligrams (mg) per day is determined by your doctor. Your doctor may adjust your dose if needed.
    - Avinza®: The capsule is given every 24 hours.
    - Kadian®: The capsule is given every 12 or 24 hours.
  - Children—Use and dose must be determined by your doctor.
For oral dosage form (extended-release tablets):
- For moderate to severe pain:
  - Adults—
    - The total amount of milligrams (mg) per day is determined by your doctor. Your doctor may adjust your dose if needed.
    - Arymo™ ER: The tablet is given every 8 or 12 hours.
    - Morphine sulfate: The tablet is given every 8 or 12 hours.
    - Morphabond™: The tablet is given every 12 hours.
    - MS Contin®: The tablet is given every 8 or 12 hours.
  - Children—Use and dose must be determined by your doctor.
For oral dosage form (solution):
- For moderate to severe pain:
  - Adults—10 to 20 milligrams (mg) every 4 hours as needed. Your doctor may adjust your dose if needed.
  - Children—Use and dose must be determined by your doctor.
For oral dosage form (tablets):
- For moderate to severe pain:
  - Adults—15 to 30 milligrams (mg) every 4 hours as needed. Your doctor may adjust your dose if needed.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose of Arymo™ ER, Avinza®, Kadian®, Morphabond™, or MS Contin®, skip the missed dose and take your next dose at your usual time the next day. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Morphine can cause serious unwanted effects if taken by adults, children, or pets who are not used to strong narcotic pain medicines. Make sure you store the medicine in a safe and secure place to prevent others from getting it.

Precautions While Using Kadian ER

It is very important that your doctor check your progress while you are taking this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. This effect may last for a few days after you stop using this medicine. Check with your doctor before taking any of these medicines while you are using this medicine.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

This medicine may make you dizzy, drowsy, confused, or disoriented. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

This medicine may cause a serious allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

If you have been using this medicine regularly for several weeks or longer, do not change your dose or suddenly stop using it without checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble sleeping.

Do not take too much of this medicine or take it more often than your doctor tells you to. This can be life-threatening. Symptoms of an overdose include: extreme dizziness or weakness, slow heartbeat or breathing, seizures, trouble breathing, and cold, clammy skin. Call your doctor right away if you notice these symptoms.

Using this medicine while you are pregnant may cause serious unwanted effects in your newborn baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using this medicine.

Using too much of this medicine may cause reduced infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.

Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Kadian ER Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Abdominal or stomach pain
blurred vision
bulging soft spot on the head of an infant
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in the ability to see colors, especially blue or yellow
chest pain or discomfort
confusion
cough
decreased urination
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast, pounding, or irregular heartbeat or pulse
headache
hives, itching, or skin rash
increased sweating
loss of appetite
nausea or vomiting
nervousness
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
severe constipation
severe vomiting
shakiness in the legs, arms, hands, or feet
slow heartbeat
sweating or chills

Incidence not known

Black, tarry stools
cold, clammy skin
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
irregular, fast or slow, or shallow breathing
lightheadedness
loss of consciousness
low blood pressure or pulse
painful urination
pale or blue lips, fingernails, or skin
pale skin
pinpoint red spots on the skin
pounding in the ears
shakiness and unsteady walk
unsteadiness, trembling, or other problems with muscle control or coordination
unusual bleeding or bruising
very slow heartbeat

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Constricted, pinpoint, or small pupils (black part of the eye)
decreased awareness or responsiveness
extreme drowsiness
fever
increased blood pressure
increased thirst
lower back or side pain
muscle cramps or spasms
muscle pain or stiffness
no muscle tone or movement
severe sleepiness
swelling of the face, fingers, or lower legs
weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Cramps
difficulty having a bowel movement (stool)
drowsiness
false or unusual sense of well-being
relaxed and calm feeling
sleepiness or unusual drowsiness
weight loss