Composition: Morphine sulphate 35mg, 50mg, 75mg and 100mg.
Presentation: Rectal tampon (non-dissolving, controlled release, suppository).
Storage and stability: Do not store above 25C. Do not refrigerate.
Action: Opioid analgesic.
Indications: Short-term treatment of severe pain in advanced cancer when the oral route is no longer feasible for administering morphine.
Contraindications: As for other morphine preparations. Sensitivity to any of the hydrogel polymer components. Patients with painful conditions of the rectum or anus. Use with caution in patients with tumour of the rectum where excess mucus is produced. Use should be avoided in patients presenting with neutropenia.
Dosage and administration: A small amount of aqueous gel should be applied to the unit and the anal sphincter. One suppository should then be inserted into the rectum. After approximately 24 hours, the suppository should be expelled and replaced. Up to two units may be inserted together to provide dosages between 35mg and 200mg. For patients stabilised on morphine, the dose conversion is 1:1 from total daily morphine (or equivalent) to Moraxen given rectally once daily. Patients started on Moraxen without having received previous morphine treatment should be started with a dose equivalent to the total daily oral dose that would be initiated in the same circumstances. Moraxen should be expelled either during a normal bowel movement or by the patient bearing down to induce a bowel movement. If difficulty in expelling the product is experienced after 30 hours, removal can be assisted by inserting one or two glycerin suppositories, or other stimulant suppositories, or by digital extraction by the patient or medical/nursing personnel.
Elderly or debilitated patients, use with caution.
Severe renal or hepatic insufficiency, use with caution.
Children aged 18 years or younger, should not be used.
Pregnancy, not recommended. Should only be used where need for strong opioid analgesia justifies the potential risk to the foetus.
Lactation, not recommended (see SPC).
Overdosage: Moraxen should be removed immediately. Medical management involves respiratory support and intravenous administration of naloxone See SPC for further details.
Precautions: As for morphine. Replacement Moraxen suppositories should only be inserted after a used one has been removed. If lost due to defaecation, a new suppository should be inserted immediately.
Drug interactions: As for morphine.
Side effects: As for other opioid analgesics. Following use in some patients, erythema, rectal bleeding and anal irritation have been described.
Net price: 7 35mg £10, 50mg £10.50, 75mg £15.75, 100mg £21. A tube of aqueous lubricating gel is supplied in each pack.
Supplier: Schwarz Pharma, Schwarz House, East Street, Chesham, Buckinghamshire HP5 1DG. Tel 01494 797500, fax 01494 792330.
Legal class: CD (Sch 2) POM.