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10/2/2019

Morphine PCA Vials

Products Affected - Description

    • Morphine injection, ICU Medical, 1 mg/mL, 30 mL PCA vial, 25 count, NDC 00409-2029-02
    • Morphine injection, ICU Medical, 5 mg/mL, 30 mL PCA vial, 25 count, NDC 00409-6028-04 - discontinued

Reason for the Shortage

    • ICU Medical has morphine PCA vials on shortage due to manufacturing delays. The 5 mg/mL 30 mL vials were discontinued in late-2019.[1]
    • Amphastar's morphine PCA vials are not affected by the shortage.[2]

Available Products

    • Morphine injection, Amphastar, 1 mg/mL, 30 mL PCA vial, 10 count, NDC 76329-1911-01

Estimated Resupply Dates

    • ICU Medical has morphine 1 mg/mL 30 mL PCA vials on back order and the company estimates a release date of late-April 2020.[1]

Implications for Patient Care

    • Morphine sulfate is an opiate agonist labeled for analgesia.[3] ICU Medical's preservative-free morphine sulfate PCA vials are for use with a compatible Hospira (ICU Medical) PCA pump set, injector, and infusion device.[3]

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.[4] Use extra caution not to confuse these agents.[4]
    • No other opioid agonist can be substituted for morphine on a mg-per-mg basis.[5]

Alternative Agents & Management

    • Hospitals using ICU Medical's PCA pump set, injector and infusion device should conserve current morphine PCA supplies. Carefully determine each patient's need for 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 opiod analgesics compared to nurse administered intravenous opioid analgesics.[6] Additionally, intramuscular opioids ordered on an as-needed basis are not a preferred route of administration.[6]
    • Use multimodal pain management whenever possible.[7]
    • Utilize stakeholder clinicians to help make plans for specific patient populations.

References

    1. ICU Medical. Customer Service (personal communications or website). June 6 and 25, August 6 and 24, December 4, 2018; January 18, April 19, June 11, July 29, September 5, and October 2, 2019.
    2. Amphastar. Customer Service (personal communications). June 7 and 25, 2018.
    3. Morphine Sulfate Preservative-Free Injection [product information]. Lake Forest, IL: Hospira, 2016.
    4. 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.
    5. Momeni M, Crucitti M, De Kock M. Patient controlled analgesia in the management of postoperative pain. Drugs 2006; 66(18): 2321-2337.
    6. 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.
    7. Dickerson DM. Acute Pain Management. Anesthesiology Clinics 2014;32(2): 495-504.

Updated

Updated October 2, 2019 by Michelle Wheeler, PharmD, Drug Information Specialist. Created June 8, 2018 by Leslie Jensen, PharmD, Drug Information Specialist. © 2019, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Vizient 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. Vizient, 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 Vizient, 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 Vizient, ASHP nor University of Utah endorses or recommends the use of any drug.

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