Products Affected - Description

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

Reason for the Shortage

• • ICU Medical discontinued morphine 1mg/mL 30 mL PCA vials in May 2020. 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

• • Amphastar has morphine PCA vials available.

• • 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]

• • 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]

• • 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.

• 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, October 2, December 16, 2019; and March 6, 2020.
  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.