Pain Management Question

[CaliCPhT]

So morphine sulfate comes in a soluble tablet intended for IM or SQ injection (10, 15, & 30mg). I've seen several prescriptions written for morphine to be used sublingually. Can a patient use the soluble tablets sublingually? Is it readily absorbed? My assumption is that there are probably more effective alternatives, but I am not one to say. Anyone know?

Thanks for putting up with my silly questions!!

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[Aznfarmerboi]

I can take a shot on this off the bat, but not too sure. . . and too busy to look it up right now. However, the answer is no. You cannot use a soluble tablet for IM or SQ, as a sublingual tablet. The tablet is usually not readily absorbed, as IM and SQ bolus tablet is meant for it to be dissolved over a longer duration of time (I think it is 7-8 minutes, with peak plasma levels in about 10-20 minutes), while most sublingual tablets are meant to be dissolved faster. Furthermore IM and SQ tablet to a certain extent (just guessing), would have a more non polar base so that they can be stable (since you are injecting it into fat). The partition coefficient of the soluble tablet would be different IM or SQ as opposed to your mouth.

For the management of pain medication, you should refer to the dosing conversion from one drug to another, and different formulation to another formulation.

 

[sdn1977]

Actually, you can use the soluble tablet for sl administration. It is readily soluble & absorbs well from the oral mucosa, even in this tablet form.

I'm pretty certain no one uses these tablets anymore for injection (legally anyway), although they certainly can be.

They are a very, very old holdover from WWII years when medics had to carry morphine, but there were no disposable syringes. So, the drug was solubilized, drawn up into a glass syringe with a reusable needle & administered. The syringe was taken apart, the needle removed & they were all "sterilized" by boiling, if possible.

Now, the soluble tablets are used as "immediate" release ms, rather than the "extended" release product.

When ms needs to be given sl, it really is better given as the oral concentrate - 20mg/ml. Its less fluid & these pts often are terminal & have a hard time swallowing even their own saliva. So, even if atropine is given sl, the ms can still be placed under the tongue as well.

When I first started in pharmacy, we still had glass syringes & reusable needles to administer phenol. The pharmacy had to fill the syringe then it was sent to central supply for sterilization & returned to the pharmacy in a sterile pack. I haven't seen that in 20 years though.....

 

[cycloketocaine]

We had bookoos of hospice patients on SL Morphine. Some did take it SL, and a few took it in a nebulizer. For an injection, we use the Morphine injectable or whatever. I've never heard of dissolving a tablet for IM use. I would think that would be kind of frowned upon in this day and age.

 

[CaliCPhT]

Actually, you can use the soluble tablet for sl administration. It is readily soluble & absorbs well from the oral mucosa, even in this tablet form.

I'm pretty certain no one uses these tablets anymore for injection (legally anyway), although they certainly can be.

They are a very, very old holdover from WWII years when medics had to carry morphine, but there were no disposable syringes. So, the drug was solubilized, drawn up into a glass syringe with a reusable needle & administered. The syringe was taken apart, the needle removed & they were all "sterilized" by boiling, if possible.

Now, the soluble tablets are used as "immediate" release ms, rather than the "extended" release product.

When ms needs to be given sl, it really is better given as the oral concentrate - 20mg/ml. Its less fluid & these pts often are terminal & have a hard time swallowing even their own saliva. So, even if atropine is given sl, the ms can still be placed under the tongue as well.

When I first started in pharmacy, we still had glass syringes & reusable needles to administer phenol. The pharmacy had to fill the syringe then it was sent to central supply for sterilization & returned to the pharmacy in a sterile pack. I haven't seen that in 20 years though.....

Awesome! thanks. The soluble tabs are only made by Ranbaxy these days, if I'm not mistaken. Interesting bits of history in there too!

 

[cycloketocaine]

Awesome! thanks. The soluble tabs are only made by Ranbaxy these days, if I'm not mistaken. Interesting bits of history in there too!

We used to get Ethex too......but stopped because Ranbaxy was cheaper. I think you can still get Ethex though.

 

[tussionex]

wow, they still make soluble tablets of morphine!

i agree with sdn...i would use the concentrate for SL use, much less fluid, less risk of choking, etc...
or nebulized morphine is always fun!