MS-Contin 13 an oral controlled-release preparation of morphine sulfate that has been used widely in the management of advancd cancer pain. It prolongs plasma concentration of morphine with no observable accumulation properties following repeated
dosing, thereby promoting uninterrupted sleep and hopefully improving patient's quality of life. The common side effects of MS Contin are nausea, vomiting, drowsiness and constipation. But these symptoms are usually mild and respiratory
depression
is a
rare problem. We experienced respiratory depression during oral administration of MS contin for the pain management of advanced gall bladder cancer of 76 years old male patient with metastasis at liver, intestine and cervical lymph node. After we
increased the dosage of MS Contin from 160mg to 220mg per day, due to abdominal pain, we observed morphine reaction of MS Contin overdose such as pinpoint pupil, deeply slow respiration below 8/minute, and drowsiness. After intravenous bolus
injection
of 0.4 mg naloxone followed by continuous administration of 0.2 mg/hr for 4 hlurs, the patient regained consciousness. The administered route of morphine was changed to intravenous PCA (patient controlled analgesia). There was no aspiration sign
as
confirmed by chest x-ray. The patient was comfortable and delayed no signs of respiratory depression until now.
|