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Morphine PCA Vials

[09 June 2016]

Products Affected - Description

Morphine injection, Hospira
5 mg/mL, 30 mL PCA vial, 25 count (NDC 00409-6028-04)

Reason for the Shortage

Hospira has morphine PCA vials on shortage due to quality assurance issues.1

Available Products

Morphine injection, Hospira
1 mg/mL, 30 mL PCA vial, 25 count (NDC 00409-2029-02)

Estimated Resupply Dates

Hospira has morphine 5 mg/mL 30 mL PCA vials on back order and the company estimates a release date of early-July 2016.1

Implications for Patient Care

Morphine sulfate is an opiate agonist labeled for analgesia.2 Hospira's preservative-free morphine sulfate PCA vials are for use only with a compatible Hospira PCA pump set, injector and infusion device.2

Safety

  • Use extreme vigilance when switching between different formulations of morphine sulfate and when switching to alternative opioid agonists. Patient harm can occur if these agents are dosed erroneously.3 Use extra caution not to confuse these agents.3
  • No other opioid agonist can be substituted for morphine on a mg-per-mg basis.4

Alternative Agents & Management

  • Hospitals using Hospira's PCA pump set, injector and infusion device should conserve current morphine PCA supplies. Carefully determine each patient's need for morphine PCA.
  • For hospitals using Hospira PCA pumps, there is a shortage of empty PCA vials and injectors, thus limiting the possibility of preparing a morphine PCA.
  • The 2012 ASA Practice Guidelines for Acute Pain Management in the Perioperative Setting state there are equivocal findings regarding the analgesic efficacy of intravenous PCA opioid analgesics compared to nurse administered intravenous opioid analgesics.5 Additionally, intramuscular opioids ordered on an as-needed basis are not a preferred route of administration.5
  • Use multimodal pain management whenever possible.6
  • Utilize stakeholder clinicians to help make plans for specific patient populations.

Related Shortages

References

  1. Hospira (personal communications and website). December 10 and 11, 2015; January 13 and 26, April 25, and June 8, 2016.
  2. Morphine Sulfate Preservative-Free Injection [product information]. Lake Forest, IL: Hospira; 2006.
  3. Institute for Safe Medication Practices. A Shortage Of Everything Except Errors: Harms Associated with Drug Shortages. Acute Care ISMP Medication Safety Alert. April 19, 2012.
  4. Momeni M, Crucitti M, De Kock M. Patient controlled analgesia in the management of postoperative pain. Drugs 2006; 66(18):2321-2337.
  5. American Society of Anesthesiologists Task Force on Acute Pain Management : Practice guidelines for acute pain management in the perioperative setting. Anesthesiology 2012; 116: 248-273
  6. Dickerson DM. Acute Pain Management. Anesthesiology Clinics 2014;32(2): 495-504.

Updated

Updated June 9, 2016 by Michelle Wheeler, PharmD, Drug Information Specialist. Created December 10, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2016, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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