The Pharmaceutical Journal
Vol 277 No 7427 p620
18 November 2006

Society summary

Practice Committee issues new guidance on prescribing of modified release morphine

The Royal Pharmaceutical Society's Practice Committee no longer recommends brand-name prescribing of modified-release morphine preparations and fentanyl patches. This represents a change in the committee's previously held position, which has come about as a result of information received from the British National Formulary.

The committee has heard from the BNF that there is no compelling evidence to show that switching between brands of modified-release morphine preparations with the same release profile affects pain control. Also, there is no evidence of a difference in the rate of delivery between brands of fentanyl patches when used in accordance with the product licence.

However, in the case of modified-release oral morphine preparations, the BNF states that dosage requirements should be reviewed if the brand is changed.

The Practice Committee has agreed some “good practice” points that it commends to the profession:

· Pharmacists should take steps to prevent unintentional changes of the brand supplied to patients.

· If the brand of strong modified-release morphine preparations needs to be changed then the pharmacist should ensure that the patient and the patient’s carers understand and accept the need for change.

· Pharmacists should adhere to local prescribing policies on the use of long-acting modified-release morphine preparations.

· There are important differences between matrix patches and reservoir patches. Reservoir patches of fentanyl should never be cut to deliver a smaller dose because this disrupts the controlled-release mechanism. The practice of cutting fentanyl matrix patches falls outside the product licence and pharmacists should be aware that the summary of product characteristics for a brand of matrix patch states: “Durogesic DTrans patches should not be cut. No data are available on cut or divided patches.”

General enquiries relating to this guidance should be directed at Robert Clayton, in the Society’s practice and quality improvement directorate, (tel 020 7572 2207, e-mail practice@rpsgb.org).